Chapter 50: Diabetes and Hypoglycemia
Linton: Medical-Surgical Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse explains that type 1 diabetes mellitus is a disease in which the body does not produce enough insulin. What is the reason
that the blood glucose is elevated?
a. Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth
hormone) levels
b. Malfunction of the glycogen-storing capabilities of the liver
c. Destruction of the beta cells in the pancreas
d. Insulin resistance of the receptor cells in the muscle tissue
ANS: C
Type 1 diabetes mellitus is a disease in which the pancreas does not produce adequate insulin because of the destruction of beta
cells.
DIF: Cognitive Level: Comprehension
REF: p. 968
OBJ: 2
TOP: Type 1 Diabetes Mellitus
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. A patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill instead of insulin. The nurse
explains that in type 2 diabetes mellitus, the body still makes insulin. What other information is pertinent for the nurse to relay?
a. Overweight and underactive people cannot simply use the insulin produced.
b. Metabolism is slowed in some people, so they have to take a pill to speed up their
metabolism.
c. Sometimes the autoimmune system works against the action of the insulin.
d. The cells become resistant to the action of insulin. Pills are given to increase the
sensitivity.
ANS: D
Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of insulin and the blood glucose level rises.
Oral hyperglycemic agents make the cells more sensitive.
DIF: Cognitive Level: Comprehension
REF: pp. 981-982 OBJ: 2
TOP: Type 2 Diabetes Mellitus
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
3. A patient tells a nurse that she eats “huge” amounts of food but stays hungry most of the time. What should the nurse explain as the
cause of hunger experienced by persons with type 1 diabetes?
a. Excess amount of glucose
b. Need for additional calories to correct the increased metabolism
c. Fact that the cells cannot use the blood glucose
d. Need for exercise to stimulate insulin secretion
ANS: C
The cells cannot use the glucose without insulin, so the patient with diabetes still feels hungry even though abundant glucose is
circulating in the blood.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Comprehension
REF: p. 968
OBJ: 1
Hunger in the Patient with Diabetes
Nursing Process Step: Implementation
NCLEX: Physiological Integrity: Physiological Adaptation
4. What does the lack of insulin in patients with type 1 diabetes cause that increases the risk for cardiovascular disorders?
a. High glucose levels that irritate and shrink the vessels
b. Inadequate metabolism of proteins, which causes ketosis
c. Increased fatty acid levels
d. Increased metabolism of ketones, which causes hypertension
ANS: C
The increase in fatty acid levels causes an increase in the level of triglycerides and an attendant rise in low-density lipoprotein
levels.
DIF: Cognitive Level: Knowledge
REF: pp. 968-969 OBJ: 1
TOP: Diabetes: Complications
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
5. The self-care goal of a patient with diabetes is to keep the blood sugar within normal limits. What causes hyperglycemia to occur?
a. Blood glucose levels rise, stimulating the production of insulin.
b. Insulin conversion of glycogen to glucose is inhibited.
c. The body responds to glucose-starved tissues by changing stored glycogen into
d.
glucose.
Glycogen is unable to be stored in the liver and muscles.
ANS: C
The hypothalamus is receiving a message that the cells need glucose, so it responds by adding more glucose to the already
overburdened blood.
DIF: Cognitive Level: Comprehension
REF: p. 968
OBJ: 1
TOP: Hyperglycemia
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Copyright © 2020, Elsevier Inc. All Rights Reserved.
1
6. A young patient complains that diabetes is causing her to “have no life at all. It’s too hard.” What is the most helpful response by
the nurse?
a. “Yes, you must make some sacrifices.”
b. “It’s hard, but with significant alterations in your lifestyle, you can live a long
life.”
c. “What’s hard about exercise, diet, and medicine?”
d. “Let’s talk about what makes it so hard.”
ANS: D
Involving the patient in decisions about how she will cope with her diabetes will make the goals more realistic and personal, which
will give her a greater chance of success in meeting them.
DIF: Cognitive Level: Application
REF: p. 990
OBJ: 7
TOP: Diabetes Lifestyle
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
7. When a patient with type 2 diabetes says, “Why in the world are they looking at my hemoglobin? I thought my problem was with
my blood sugar.” What should the nurse explain about the level of hemoglobin A1c?
a. Shows how a high level of glucose can cause a significant drop in the hemoglobin
level
b. Shows what the glucose level has done during the past 3 months
c. Indicates a true picture of the patient’s nutritional state
d. Reflects the effect of a high level of glucose on the ability to produce red blood
cells (RBCs)
ANS: B
By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose can be evaluated for the past 3 months
because the glucose stays bound to the hemoglobin for the life of the RBC.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Comprehension
REF: p. 983
OBJ: 1
Hemoglobin A1c: Glycosylated Hemoglobin Level
Nursing Process Step: Implementation
NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. A patient with type 2 diabetes shows a blood sugar reading of 68 at 6 AM. What action should the nurse implement based on the
reading of 72 mg/dL?
a. Notify the charge nurse of the reading.
b. Give regular insulin per a sliding scale.
c. Give him 8 oz of skim milk.
d. Administer the oral glucose tablet.
ANS: C
The patient is hypoglycemic and needs an immediate source of glucose, such as milk or orange juice. The oral hypoglycemic agent
will not work quickly enough. The charge nurse can be notified later. Giving insulin per a sliding scale would lower the blood
sugar level.
DIF: Cognitive Level: Application
REF: p. 991
OBJ: 6
TOP: Hypoglycemic Reaction
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. A nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life-threatening condition. What will
DKA result in?
a. Disorder of carbohydrates, fats, and proteins metabolism
b. Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream
c. Dangerously elevated pH and bicarbonate levels in the blood
d. Severe hypoglycemia, which can result in coma and convulsions
ANS: A
DKA is mainly related to the use of fat as an energy source because of an inability of the body to use glucose. The metabolism of
fat produces ketones.
DIF: Cognitive Level: Knowledge
REF: p. 973
OBJ: 4
TOP: Diabetic Ketoacidosis
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
10. A patient has been admitted to the hospital with the diagnosis of DKA. What vital signs should a nurse anticipate that the patient
will exhibit?
a. Temperature, 99° F; pulse, 62 beats/min; respirations, 16 breaths/min and shallow
b. Temperature, 98.6° F; pulse, 76 beats/min; respirations, 16 breaths/min and deep
c. Temperature, 98° F; pulse, 84 beats/min; respirations, 18 breaths/min and shallow
d. Temperature, 97.4° F; pulse, 110 beats/min; respirations, 26 breaths/min and deep
ANS: D
DKA is caused by the attempt of the body to metabolize fat for energy, which results in an acidotic state. The classic signs of DKA
are hypothermia, tachycardia, and Kussmaul respirations (rapid and deep) to blow off the acid ions via respirations. The
respirations will have a fruity odor.
DIF: Cognitive Level: Analysis
REF: p. 973
OBJ: 4
TOP: Diabetic Ketoacidosis
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Copyright © 2020, Elsevier Inc. All Rights Reserved.
2
11. A home health care nurse is assessing a patient with type 1 diabetes who has been controlled for 6 months. The nurse is surprised
and concerned about a blood glucose reading of 52 mg/dL. What action by this patient most likely caused this episode of
hypoglycemia?
a. Taking a new form of birth control pill this morning
b. Using large amounts of sugar substitute in her tea this morning
c. A 2-hour long exercise class at the spa this morning
d. Administering an insufficient dose of insulin this morning
ANS: C
Excessive exercise used up the glucose that was made available by the insulin taken by the patient. The patient now has too much
insulin for the available glucose and has become hypoglycemic.
DIF: Cognitive Level: Application
REF: p. 977
OBJ: 6
TOP: Diabetes: Treatment
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
12. As part of a teaching plan in preparation for discharge, a patient with type 1 diabetes needs guidelines for exercise. Which guideline
should be included?
a. Plan exercise so that it coincides with the peak action of insulin.
b. Insulin should be injected into the lower extremity before exercise because that
site provides the greatest absorption.
c. Exercise should be performed daily at the same time of day and at the same
intensity.
d. Keep exercise at a minimum to conserve your energy.
ANS: C
If the body is using more glucose than available, the body will draw on fatty acids, which will give off ketones.
DIF: Cognitive Level: Application
REF: p. 977|p. 900
OBJ: 7
TOP: Exercise
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
13. A patient has come into the emergency department accompanied by a friend who states that the patient had been acting very
strangely and seems confused. The friend states that the patient has diabetes and takes insulin. Which signs of hypoglycemia might
the nurse assess?
a. Slow pulse rate and low blood pressure
b. Irritability, anxiety, confusion, and dizziness
c. Flushing, anger, and forgetfulness
d. Sleepiness, edema, and sluggishness
ANS: B
When blood sugar levels fall, hormones are activated to increase serum glucose. One of the hormones is epinephrine, which causes
these symptoms.
DIF: Cognitive Level: Comprehension
REF: p. 991
OBJ: 1
TOP: Hypoglycemia
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
14. A patient has come to the physician’s office after finding out that her blood glucose level was 135 mg/dL. She states that she had
not eaten before the test and was told to come and see her physician. She asks the nurse if she has diabetes. What is the most
accurate nursing response?
a. “Having a fasting serum glucose that high certainly indicates diabetes.”
b. “That test indicates that we need to perform more tests that are specific for
diabetes.”
c. “How do you feel? Do you have any other signs of diabetes?”
d. “Do you have a family history of diabetes, stroke, or heart disease? We need to
know before making a diagnosis.”
ANS: B
The nurse needs to answer the patient’s question in a way that gives information and is not misleading. Although 135 mg/dL is
high, a nonpathologic explanation may be found. More tests should be performed to evaluate the patient.
DIF: Cognitive Level: Comprehension
REF: p. 975
OBJ: 9
TOP: Laboratory Tests for Diabetes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
15. A nurse is formulating a teaching plan for a 22-year-old woman taking rosiglitazone (Avandia). What should the nurse include
information about in this plan to caution this patient?
a. Decreased effectiveness of her birth control pills
b. Excessive exposure to the sun
c. Sudden drop in blood pressure with dizziness
d. Possible severe diarrhea
ANS: A
Avandia causes some birth control pills to be less effective.
DIF: Cognitive Level: Application
REF: p. 982
OBJ: 10
TOP: Side Effects of Avandia
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
Copyright © 2020, Elsevier Inc. All Rights Reserved.
3
16. A patient with type 1 diabetes has an insulin order for NPH insulin, 35 U, to be given at 0700. The patient has also been instructed
not to take anything by mouth (NPO) in preparation for laboratory work that will not be drawn until 1000. What action should the
nurse implement?
a. Give the insulin as ordered.
b. Give the insulin with a small snack.
c. Inform the charge nurse.
d. Hold the insulin until after the blood draw.
ANS: D
Holding the insulin to adhere to the NPO order is appropriate. The patient will not be getting food until after the laboratory work;
consequently, the insulin will not be needed until then. Giving the insulin as ordered will create a possibility of hypoglycemia
before the blood is drawn. Giving a snack to a patient who is NPO is inappropriate.
DIF: Cognitive Level: Application
REF: p. 986
OBJ: 8
TOP: Insulin with NPO Order
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
17. A patient comes to the diabetes clinic and confides to the nurse that she does not follow the diet exchange program that she was
given. What is the best response by the nurse?
a. “The exchange program is a carefully developed and very important program that
allows you to take control of your disease.”
b. “A lot of people have trouble with that program. You aren’t the first one to go off
your diet.”
c. “We had better check your blood work to see what you’ve done to yourself.”
d. “Okay. Let’s talk about what you do eat and drink and how you manage your
diabetes.”
ANS: D
To evaluate the effectiveness of treatment, the nurse must first find out how the patient perceives the importance of diet, drugs, and
exercise.
DIF: Cognitive Level: Application
REF: p. 990
OBJ: 8
TOP: Nutrition
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
18. A patient with type 1 diabetes asks why his 0700 insulin has been changed from NPH insulin to 70/30 premixed insulin. What is
the best explanation by the nurse that explains about 70/30 insulin mixture?
a. It is absorbed more rapidly into the bloodstream.
b. It has no peak action time and lasts all day.
c. It makes insulin administration easier and safer.
d. It provides a bolus of rapid-acting insulin to prevent hyperglycemia after
breakfast.
ANS: C
70/30 insulin is 30% rapid-acting insulin and 70% intermediate-acting insulin. The rapid action of the 0700 premixed insulin
prevents hyperglycemia after the morning meal and the mixed drug reduces the risk of error in drawing up two insulins.
DIF: Cognitive Level: Comprehension
REF: p. 978
OBJ: 8
TOP: Use of 70/30 Insulin
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
19. What should a nurse include when drawing up a patient’s diabetes teaching plan?
a. Develop an exercise plan because regular exercise helps control blood glucose
b.
c.
d.
levels.
Monitor blood sugar levels only if not feeling well to ensure that the fingertips are
not pricked too much.
If nervousness, palpitations, or hunger is experienced, take a small dose (1 to 2 U)
of regular insulin and call the physician.
Use over-the-counter measures for any foot blisters, calluses, or wounds before
seeking medical help.
ANS: A
Exercise is an integral part of the patient’s ability to take charge of his or her diabetes and needs to be included in the teaching plan.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Application
REF: p. 977|p. 990
8
TOP: Diabetes Teaching Plan
Nursing Process Step: Planning
NCLEX: Physiological Integrity: Basic Care and Comfort
20. What has most likely occurred in a patient who has been diagnosed with endogenous hypoglycemia?
a. Taken an overdose of hypoglycemic drugs
b. Been following a very restricted fasting diet or is malnourished
c. Excessive secretion of insulin or an increase in glucose metabolism
d. Exercised unwittingly without replenishing needed fluids and nutrients
ANS: C
Endogenous refers to within; in this patient, it refers to internal factors, such as an increase of insulin or glucose metabolism. Both
conditions would lead to hypoglycemia.
DIF: Cognitive Level: Application
REF: p. 991
OBJ: 1
TOP: Hypoglycemia
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Copyright © 2020, Elsevier Inc. All Rights Reserved.
4
21. How long does it take for Humulin R 20 units to peak?
a. 15 minutes
b. 30 minutes
c. 1 hour
d. 2 hours
ANS: D
Humulin R has its onset in approximately 30 minutes, but its peak is in 2 hours.
DIF: Cognitive Level: Knowledge
REF: p. 979
OBJ: 8
TOP: Humulin R Insulin Peak
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
22. A nurse suspects that a patient with type 1 diabetes may be experiencing the Somogyi phenomenon. What symptom supports this
suspicion?
a. Headache on awakening and enuresis
b. 6 AM blood sugar of 58 mg/dL and nausea
c. Abdominal pain and elevated blood pressure
d. Drowsiness and disorientation after eating
ANS: A
The Somogyi phenomenon occurs because of a rebound hyperglycemia after a period of hypoglycemia during the early morning.
The patient wakes with a headache, enuresis, nausea and vomiting, nightmares, and a high level of blood sugar.
DIF: Cognitive Level: Comprehension
REF: p. 983
OBJ: 8
TOP: Somogyi Phenomenon
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
23. A patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS). The blood glucose level is very high
(880 mg/dL) on admission. The physician believes that the condition is the result of large amounts of glucose solutions
administered intravenously (IV) during renal dialysis. What should the nurse anticipate that the patient would exhibit?
a. Fruity breath and a high level of ketones in her urine
b. Severe dehydration and hypernatremia caused by the hyperglycemia
c. Exactly the same symptoms and signs as DKA
d. Kussmaul respirations, nausea, and vomiting
ANS: B
IV solutions containing glucose bypass the digestive system; consequently, the pancreas is not triggered to release insulin.
However, just enough insulin is present to prevent the breakdown of fatty acids and the formation of ketones.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Application
REF: pp. 974-975 OBJ: 5
Hyperglycemic Hyperosmolar Nonketotic Syndrome
Nursing Process Step: Assessment
NCLEX: Physiological Integrity: Physiological Adaptation
MULTIPLE RESPONSE
1. What are functional causes of hypoglycemia? (Select all that apply.)
a. Dumping syndrome
b. Overdose of insulin
c. Addison disease
d. Prolonged muscular exercise
e. Chronic alcoholism
ANS: A, C, D
Dumping syndrome, Addison disease, and prolonged exercise are functional causes of hypoglycemia. Overdose of insulin and
chronic alcoholism are exogenous causes.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Knowledge
REF: p. 991
OBJ: 1
Functional Causes of Hypoglycemia
Nursing Process Step: Implementation
NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
2. What should a teaching plan about foot care include for a patient with diabetes? (Select all that apply.)
a. Wash and carefully dry the feet every day.
b. Apply lotion between the toes.
c. Protect the feet from extreme temperatures.
d. Walk barefoot only indoors.
e. Buy shoes that are comfortable and supportive.
ANS: A, C, E
Washing, inspecting, and drying the feet, especially between the toes, are essential. Protecting the feet from heat and cold and
wearing supportive shoes are important to good foot health. Lotion can be applied to the soles and tops of the feet but not between
the toes. Walking barefoot is contraindicated for a person with diabetes.
DIF: Cognitive Level: Knowledge
REF: pp. 971-972 OBJ: 5
TOP: Foot Care
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
Copyright © 2020, Elsevier Inc. All Rights Reserved.
5
3. A teaching plan for a patient with diabetes is focused on smoking cessation and the control of hypertension for the avoidance of
microvascular complications. What are examples of microvascular complications? (Select all that apply.)
a. Macular degeneration
b. End-stage renal disease (ESRD)
c. Coronary artery disease (CAD)
d. Peripheral vascular disease (PVD)
e. Cerebrovascular accident (CVA)
ANS: A, B
Macular degeneration and ESRD are both microvascular complications. CAD, PVD, and CVA are all macrovascular
complications.
DIF: Cognitive Level: Comprehension
REF: p. 970
OBJ: 5
TOP: Microvascular Complications
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
4. How is the Whipple triad described? (Select all that apply.)
a. Symptoms of hypoglycemia are present.
b. Low blood glucose levels are documented when symptoms are present.
c. Symptoms can be reproduced with an injection of regular insulin, 10 units.
d. Muscular activity does not have any effect on blood glucose.
e. Symptoms improved when the blood glucose level rises.
ANS: A, B, E
Whipple triad is the presence of the symptoms of hypoglycemia (e.g., diaphoresis, pallor, tachycardia), the documentation of low
blood glucose levels when symptoms are present, and the improvement of symptoms as the blood glucose level rises.
DIF: Cognitive Level: Comprehension
TOP: Whipple Triad
MSC: NCLEX: N/A
REF: p. 991
OBJ: 9
KEY: Nursing Process Step: N/A
COMPLETION
1. A nurse reminds a patient with type I diabetes to rotate the insulin injection sites to prevent ______.
ANS:
lipohypertrophy
Using the same area for insulin injections causes swollen lumpy areas that interfere with the absorption of insulin.
DIF: Cognitive Level: Comprehension
REF: p. 980
OBJ: 5
TOP: Lipohypertrophy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
2. A nurse instructs a patient about how insulin affects blood glucose. ______ (Arrange the events in sequence. Do not separate
answers with a space or punctuation. Example: ABCD.)
a. Beta cells are stimulated to release insulin.
b. Glucose enters the bloodstream.
c. Glycogen is converted to glucose by alpha cells (glycogenesis).
d. Glycogen is stored in the liver.
e. Insulin transports glucose to muscle cells.
ANS:
BAEDC
Insulin transports the glucose to muscle cells or converts it to glycogen, which is stored in the liver to be accessed when
hypoglycemia occurs.
DIF: Cognitive Level: Analysis
REF: pp. 967-968 OBJ: 3
TOP: Insulin’s Effect on Glucose
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
Copyright © 2020, Elsevier Inc. All Rights Reserved.
6