Chapter 48: Diabetes Mellitus and Hypoglycemia
Linton: Introduction to Medical–Surgical Nursing, 6th 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
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.
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
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
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
glucose.
d.
Glycogen is unable to be stored in the liver and muscles.
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.”
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)
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.
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
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
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
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.
13. A nurse preparing to administer insulin to a patient who has type 1 diabetes. The physician
has prescribed two types of insulin, 10 U of regular insulin and 35 U of neutral protamine
Hagedorn (NPH) insulin. Which is the proper procedure for the nurse to follow when
preparing these medications?
a.
Draw up the insulins in two separate syringes to avoid confusion.
b.
Draw up the regular insulin before drawing up the NPH insulin.
c.
Inject air into the NPH insulin, draw it up to 35 U, and then inject air into the clear
regular insulin and withdraw to 45 U.
d.
Inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin,
withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.
14. 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
15. 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.”
16. 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
17. 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.
18. 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.”
19. 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.
20. 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
levels.
b.
Monitor blood sugar levels only if not feeling well to ensure that the fingertips are
not pricked too much.
c.
If nervousness, palpitations, or hunger is experienced, take a small dose (1 to 2 U)
of regular insulin and call the physician.
d.
Use over-the-counter measures for any foot blisters, calluses, or wounds before
seeking medical help.
21. 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
22. How long does it take for Humulin R 20 units to peak?
a.
15 minutes
b.
30 minutes
c.
1 hour
d.
2 hours
23. 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
24. 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
MULTIPLE RESPONSE
25. 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
26. 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.
27. 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)
28. 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.
COMPLETION
29. A nurse reminds a patient with type I diabetes to rotate the insulin injection sites to prevent
_____.
OTHER
30. A nurse instructs a patient about how insulin affects blood glucose. (Arrange the events in
sequence. Separate letters by a comma and space as follows: A, B, C, D.)
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.
