Chapter 49 Bridge to NCLEX Examination
The number of the question corresponds to the same-numbered outcome at the beginning of the chapter.
1.
Polydipsia and polyuria related to diabetes mellitus are primarily due to
a.
the release of ketones from cells during fat metabolism.
b.
fluid shifts resulting from the osmotic effect of hyperglycemia.
c.
damage to the kidneys from exposure to high levels of glucose.
d.
changes in RBCs resulting from attachment of excessive glucose to hemoglobin.
1. Correct answer: b
Rationale: The osmotic effect of glucose produces the manifestations of polydipsia and polyuria.
2.
Which statement would be correct for a patient with type 2 diabetes who was admitted to the
hospital with pneumonia?
a.
The patient must receive insulin therapy to prevent ketoacidosis.
b.
The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin.
c.
The patient has minimal or absent endogenous insulin secretion and requires daily insulin
injections.
d.
The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for
hyperosmolar hyperglycemic syndrome.
2. Correct answer: d
Rationale: Hyperosmolar hyperglycemic syndrome (HHS) is a life-threatening syndrome that can occur in a
patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis (DKA) but not
enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.
3.
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result
will need further assessment?
a.
A1C 9%
b.
BP 126/80 mm Hg
c.
FBG 130 mg/dL (7.2 mmol/L)
d.
LDL cholesterol 100 mg/dL (2.6 mmol/L)
3. Correct answer: a
Rationale: Lowering hemoglobin A1C (to less than 7%) reduces microvascular and neuropathic complications.
Tighter glycemic control (normal hemoglobin A1C level, less than 6%) may further reduce complications but
increases hypoglycemia risk.
4.
Which statement by the patient with type 2 diabetes is accurate?
a.
“I am supposed to have a meal or snack if I drink alcohol.”
b.
“I am not allowed to eat any sweets because of my diabetes.”
c.
“I do not need to watch what I eat because my diabetes is not the bad kind.”
d.
“The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar.”
4. Correct answer: a
Rationale: Alcohol should be consumed with food to reduce the risk of hypoglycemia.
5.
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential
to include in your patient teaching before discharge from the hospital (select all that apply)?
a.
Insulin administration
b.
Elimination of sugar from diet
c.
Need to reduce physical activity
d.
Use of a portable blood glucose monitor
e.
Hypoglycemia prevention, symptoms, and treatment
5. Correct answers: a, d, e
Rationale: The nurse ensures that the patient understands the proper use of insulin. The nurse teaches the
patient how to use the portable blood glucose monitor and how to recognize and treat signs and symptoms of
hypoglycemia and hyperglycemia.
6.
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of
blurred vision and irritability?
a.
Call the physician.
b.
Administer insulin as ordered.
c.
Check the patient's blood glucose level.
d.
Assess for other neurologic symptoms.
6. Correct answer: c
Rationale: Blood glucose testing should be performed whenever hypoglycemia is suspected so that immediate
action can be taken if necessary.
7.
A diabetic patient has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive.
After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar
hyperglycemic syndrome based on the finding of
a.
polyuria.
b.
severe dehydration.
c.
rapid, deep respirations.
d.
decreased serum potassium.
7. Correct answer: c
Rationale: Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry
mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and
weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs
become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia
and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body’s attempt
to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the
breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial
blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the
urine or blood.
8.
Which are appropriate therapies for patients with diabetes mellitus (select all that apply)?
a.
Use of statins to treat dyslipidemia
b.
Use of diuretics to treat nephropathy
c.
Use of ACE inhibitors to treat nephropathy
d.
Use of serotonin agonists to decrease appetite
e.
Use of laser photocoagulation to treat retinopathy
8. Correct answers: a, c, e
Rationale: In patients with diabetes who have microalbuminuria or macroalbuminuria, angiotensin-converting
enzyme (ACE) inhibitors (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor antagonists (ARBs) (e.g.,
losartan [Cozaar]) should be used. Both classes of drugs are used to treat hypertension and have been found to
delay the progression of nephropathy in patients with diabetes. The statin drugs are the most widely used lipidlowering agents. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with
proliferative retinopathy, in those with macular edema, and in some cases of nonproliferative retinopathy.