Diabetes
A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive.
What is the nurses most plausible conclusion based on this assessment finding?
A) The patient should withhold his next scheduled dose of insulin.
B) The patient should promptly eat some protein and carbohydrates.
C) The patients insulin levels are inadequate.
D) The patient would benefit from a dose of metformin (Glucophage).
Ans: C
Feedback:
Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is
deteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin
will not cause short-term resolution of hyperglycemia.
2. A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would
support checking blood levels for the diagnosis of diabetes?
A) Fasting plasma glucose greater than or equal to 126 mg/dL
B) Random plasma glucose greater than 150 mg/dL
C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
D) Random plasma glucose greater than 126 mg/dL
Ans: A
Feedback:
Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater
than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.
3. A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline
would be important to teach the patients at this class?
A) Low fat generally indicates low sugar.
B) Protein should constitute 30% to 40% of caloric intake.
C) Most calories should be derived from carbohydrates.
D) Animal fats should be eliminated from the diet.
Ans: C
Feedback:
Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic
Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived
from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not
automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.
4. A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus
and her family. The nurse teaches the patient and family that which of the following nonpharmacologic
measures will decrease the bodys need for insulin?
A) Adequate sleep
B) Low stimulation
C) Exercise
D) Low-fat diet
Ans: C
Feedback:
Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride
levels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate
sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.
5. A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration
record includes the administration of regular insulin three times daily. Knowing that the patients lunch
tray will arrive at 11:45, when should the nurse administer the patients insulin?
A) 10:45
B) 11:15
C) 11:45
D) 11:50
Ans: B
Feedback:
Regular insulin is usually administered 2030 min before a meal. Earlier administration creates a risk for
hypoglycemia; later administration creates a risk for hyperglycemia.
6. A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic
agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood
glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?
A) A sulfonylurea
B) A biguanide
C) A thiazolidinedione
D) An alpha glucosidase inhibitor
Ans: B
Feedback:
Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and
therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by
the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance
insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas.
Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system,
resulting in a lower postprandial blood glucose level.
7. A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What
guideline applies to periods of illness in a diabetic patient?
A) Do not eliminate insulin when nauseated and vomiting.
B) Report elevated glucose levels greater than 150 mg/dL.
C) Eat three substantial meals a day, if possible.
D) Reduce food intake and insulin doses in times of illness.
Ans: A
Feedback:
The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses
when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent
dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels
will rise but should be reported if they are greater than 300 mg/dL.
8. The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address
what topic during this dialogue?
A) The need for frequent eye examinations for patients with diabetes
B) The fact that patients with diabetes have an elevated risk of myocardial infarction
C) The relationship between kidney function and blood glucose levels
D) The need to monitor urine for the presence of albumin
Ans: B
Feedback:
Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the
effects on vision and renal function are considered to be microvascular.
9. A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the
following actions has the greatest potential to reduce an individuals risk for developing diabetes?
A) Have blood glucose levels checked annually.
B) Stop using tobacco in any form.
C) Undergo eye examinations regularly.
D) Lose weight, if obese.
Ans: D
Feedback:
Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease.
Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not
screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.
10. A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is
subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are being
destroyed, the patient would be diagnosed with what type of diabetes?
A) Type 1 diabetes
B) Type 2 diabetes
C) Noninsulin-dependent diabetes
D) Prediabetes
Ans: A
Feedback:
Beta cell destruction is the hallmark of type 1 diabetes. Noninsulin-dependent diabetes is synonymous
with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell
destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of
hyperglycemia, often during illness or pregnancy.
11. A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse
is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase.
B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to
control it.
C) The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin.
D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin
normally breaks it down.
Ans: D
Feedback:
Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin
production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose
derived from food cannot be stored in the liver and remains circulating in the blood, which leads to
postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion.
The body does not make glucose.
12. An occupational health nurse is screening a group of workers for diabetes. What statement should the
nurse interpret as suggestive of diabetes?
A) I’ve always been a fan of sweet foods, but lately I’m turned off by them.
B) Lately, I drink and drink and cant seem to quench my thirst.
C) No matter how much sleep I get, it seems to take me hours to wake up.
D) When I went to the washroom the last few days, my urine smelled odd.
Ans: B
Feedback:
Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia.
Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.
13. A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands
the primary treatment for type 2 diabetes when the patient states what?
A) I read that a pancreas transplant will provide a cure for my diabetes.
B) I will take my oral antidiabetic agents when my morning blood sugar is high.
C) I will make sure to follow the weight loss plan designed by the dietitian.
D) I will make sure I call the diabetes educator when I have questions about my insulin.
Ans: C
Feedback:
Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic
agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a
single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some
patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it
is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.
14. A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of
caloric intake. What do the ADAs recommendations include?
A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein
C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein
D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein
Ans: D
Feedback:
Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association)
recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat,
and the remaining 10% to 20% from protein.
15. An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The
patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the
patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of
hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?
A) Administration of antihypertensive medications
B) Administering sodium bicarbonate intravenously
C) Reversing acidosis by administering insulin
D) Fluid and electrolyte replacement
Ans: D
Feedback:
The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration.
Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium
bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin
administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in
diabetic ketoacidosis (DKA).
16. A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the
best way to assess the patients ability to prepare and self-administer insulin?
A) Ask the patient to describe the process in detail.
B) Observe the patient drawing up and administering the insulin.
C) Provide a health education session reviewing the main points of insulin delivery.
D) Review the patients first hemoglobin A1C result after discharge.
Ans: B
Feedback:
Nurses should assess the patients ability to perform diabetes related self-care as soon as possible during the hospitalization
or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is
beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly
observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot
care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient.
Further education does not guarantee learning.
17. An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about
foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot
care is extremely important. Why would the nurse feel that foot care is so important to this patient?
A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.
C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
D) Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.
Ans: B
Feedback:
The nurse recognizes that providing information on the long-term complications especially foot and eye
Problems associated with diabetes is important. Avoiding amputation through early detection of foot
ulcers may mean the difference between institutionalization and continued independent living for the
elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and
may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in
circulation is related to vascular changes and is not associated with drugs administered for diabetes.
18. A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is
aware that the patient will require further teaching when the patient states what?
A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.
B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day.
C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea.
D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.
Ans: A
Feedback:
The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin when
sick. The nurse should emphasize that the patient should take insulin agents as usual and test ones blood
sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental
doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater
than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to
eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding.
If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60
minutes to prevent dehydration.
19. Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control?
A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
B) A patient who never deviates from her prescribed dose of insulin
C) A patient who adheres closely to a meal plan and meal schedule
D) A patient who eliminates carbohydrates from his daily intake
Ans: C
Feedback:
The therapeutic goal for diabetes management is to achieve normal blood glucose levels without
hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the
treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by
patients. For patients who require insulin to help control blood glucose levels, maintaining consistency
in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the
approximate time intervals between meals, and the snacks, help maintain overall glucose control.
Skipping meals is never advisable for person with type 1 diabetes.
20. A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance
test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is
conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should
explain that gestational diabetes is a result of what etiologic factor?
A) Increased caloric intake during the first trimester
B) Changes in osmolality and fluid balance
C) The effects of hormonal changes during pregnancy
D) Overconsumption of carbohydrates during the first two trimesters
Ans: C
Feedback:
Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of
placental hormones, which causes insulin resistance. The disease is not the result of food intake or
changes in osmolality.
21. A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic
hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome
most often occur?
A) Patients who are obese and who have no known history of diabetes
B) Patients with type 1 diabetes and poor dietary control
C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes
Ans: D
Feedback:
HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or
who have type 2 diabetes.
22. A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient
about self-administration of insulin in the home setting. The nurse should teach the patient to do which
of the following?
A) Avoid using the same injection site more than once in 2 to 3 weeks.
B) Avoid mixing more than one type of insulin in a syringe.
C) Cleanse the injection site thoroughly with alcohol prior to injecting.
D) Inject at a 45 angle.
Ans: A
Feedback:
To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks.
Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is
usually inserted at a 90 angle. Cleansing the injection site with alcohol is optional.
23. A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being
admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on
two occasions. The nurse would identify what likely cause for this short-term change in treatment?
A) Alterations in bile metabolism and release have likely caused hyperglycemia.
B) Stress has likely caused an increase in the patients blood sugar levels.
C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures.
D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
Ans: B
Feedback:
During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because
levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone)
increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of
previous blood sugar control, or fluid imbalance.
24. A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later
that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best
response?
A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years.
B) The cause is not known for sure but it is thought to have something to do with ketoacidosis.
C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years.
D) Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated
ketone levels.
Ans: C
Feedback:
The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High
blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible.
Ketones and ketoacidosis are not direct causes of neuropathies.
25. A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin
(Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should
prioritize which of the following assessments?
A) Monitoring the patients neutrophil levels
B) Assessing the patient for signs of impaired liver function
C) Monitoring the patients level of consciousness and behavior
D) Reviewing the patients creatinine and BUN levels
Ans: D
Feedback:
Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patients renal
function. This drug does not typically affect patients neutrophils, liver function, or cognition.
26. A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The
nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy.
Peripheral neuropathy constitutes a risk for what nursing diagnosis?
A) Infection
B) Acute pain
C) Acute confusion
D) Impaired urinary elimination
Ans: A
Feedback:
Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury
and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not
normally result in pain, confusion, or impairments in urinary function.
27. A patient has been brought to the emergency department by paramedics after being found unconscious.
The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients blood
glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?
A) IV administration of 50% dextrose in water
B) Subcutaneous administration of 10 units of Humalog
C) Subcutaneous administration of 12 to 15 units of regular insulin
D) IV bolus of 5% dextrose in 0.45% NaCl
Ans: A
Feedback:
In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50
mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five
percent dextrose would be inadequate and insulin would exacerbate the patients condition.
28. A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing
information on the prevention and management of hypoglycemia, what action should the nurse promote?
A) Always carry a form of fast-acting sugar.
B) Perform exercise prior to eating whenever possible.
C) Eat a meal or snack every 8 hours.
D) Check blood sugar at least every 24 hours.
Ans: A
Feedback:
The following teaching points should be included in information provided to the patient on how to
prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a
meal or snack every 4 to 5 hours, and check blood sugar regularly.
29. A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic
should the nurse address?
A) Signs and symptoms of diabetic nephropathy
B) Management of diabetic ketoacidosis
C) Effects of surgery and pregnancy on blood sugar levels
D) Recognition of hypoglycemia and hyperglycemia
Ans: D
Feedback:
It is imperative that newly diagnosed patients know the signs and symptoms and management of hypoand
hyperglycemia. The other listed topics are valid points for education, but are not components of the
patients immediate survival skills following a new diagnosis.
30. A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of
insulin can be stored at room temperature before it goes bad. What would be the nurses best answer?
A) If you are going to use up the vial within 1 month it can be kept at room temperature.
B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature.
C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature.
D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature.
Ans: A
Feedback:
If a vial of insulin will be used up within 1 month, it may be kept at room temperature.
31. A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the
patient and will implement a program of health education. What is the nurses priority action?
A) Ensure that the patient understands the basic pathophysiology of diabetes.
B) Identify the patients body mass index.
C) Teach the patient survival skills for diabetes.
D) Assess the patients readiness to learn.
Ans: D
Feedback:
Before initiating diabetes education, the nurse assesses the patients (and familys) readiness to learn. This
must precede other physiologic assessments (such as BMI) and providing health education.
32. A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and
finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8mmol/L). What should the school
nurse administer?
A) A combination of protein and carbohydrates, such as a small cup of yogurt
B) Two teaspoons of sugar dissolved in a cup of apple juice
C) Half of a cup of juice, followed by cheese and crackers
D) Half a sandwich with a protein-based filling
Ans: C
Feedback:
Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose
tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack
including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is
unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in
juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may
result in a sharp rise in blood sugar that will last for several hours.
33. A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for
diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase
of treatment?
A) Monitoring the patient for dysrhythmias
B) Maintaining and monitoring the patients fluid balance
C) Assessing the patients level of consciousness
D) Assessing the patient for signs and symptoms of venous thromboembolism
Ans: B
Feedback:
In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and
acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias,
decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.
34. A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is
likely to have minimal contact with the health care system. In order to ensure that the patient maintains
adequate blood sugar control over the long term, the nurse should recommend which of the following?
A) Participation in a support group for persons with diabetes
B) Regular consultation of websites that address diabetes management
C) Weekly telephone check-ins with an endocrinologist
D) Participation in clinical trials relating to antihyperglycemics
Ans: A
Feedback:
Participation in support groups is encouraged for patients who have had diabetes for many years as well
as for those who are newly diagnosed. This is more interactive and instructive than simply consulting
websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation
in research trials may or may not be beneficial and appropriate, depending on patients circumstances.
35. A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority
instruction for the nurse to give the patient?
A) Examine feet weekly for redness, blisters, and abrasions.
B) Avoid the use of moisturizing lotions.
C) Avoid hot-water bottles and heating pads.
D) Dry feet vigorously after each bath.
Ans: C
Feedback:
High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes,
soaking the feet, and shaving calluses, should be avoided.
Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling,
redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After
a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.
36. A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most
appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?
A) Ask the patient to describe an optimally healthy meal.
B) Ask the patient to keep a food diary and review it with the nurse.
C) Ask the patients family what he typically eats.
D) Ask the patient to describe a typical days food intake.
Ans: B
Feedback:
Reviewing the patients actual food intake is the most accurate method of gauging the patients diet.
37. The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the
presence of microalbuminuria. What is the nurses most appropriate action?
A) Teach the patient about actions to slow the progression of nephropathy.
B) Ensure that the patient receives a comprehensive assessment of liver function.
C) Determine whether the patient has been using expired insulin.
D) Administer a fluid challenge and have the test repeated.
Ans: A
Feedback:
Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such,
educational interventions addressing this microvascular complication are warranted. Expired insulin
does not cause nephropathy, and the patients liver function is not likely affected. There is no indication
for the use of a fluid challenge.
38. A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse
should question the patient about what sign or symptom that would suggest the possible development of
peripheral neuropathy?
A) Persistently cold feet
B) Pain that does not respond to analgesia
C) Acute pain, unrelieved by rest
D) The presence of a tingling sensation
Ans: D
Feedback:
Although approximately half of patients with diabetic neuropathy do not have symptoms, initial
symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations
(especially at night). Cold and intense pain are atypical early signs of this complication.
39. A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular
dose of insulin. What else should the nurse tell the patient?
A) Make sure to stick to your normal diet.
B) Try to eat small amounts of carbs, if possible.
C) Ensure that you check your blood glucose every hour.
D) For now, check your urine for ketones every 8 hours.
Ans: B
Feedback:
For prevention of DKA related to illness, the patient should attempt to consume frequent small portions
of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking
fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed
every 3 to 4 hours.
40. A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and
is experiencing HHS. The nurse should identify what components of HHS? Select all that apply.
A) Leukocytosis
B) Glycosuria
C) Dehydration
D) Hypernatremia
E) Hyperglycemia
Ans: B, C, D, E
Feedback:
In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and
electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the
extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity
occur. Leukocytosis does not take place.