February 19 3rd Appraisal Exam
February 19 3rd Appraisal Exam
Englatiera
Block AAA
23. A client with type 2 diabetes mellitus has a blood glucose level higher than 600 mg/dL and is
complaining of polydipsia, polyuria, weight loss, and weakness. A nurse reviews the physician's
documentation and would expect to note which of the following diagnoses?
a. Hypoglycemia
b. Pheochromocytoma
c. Diabetic ketoacidosis (DKA)
d. Hyperglycemic hyperosmolar syndrome (HHS)
24. A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of
hypoglycemia with exercising. Which statement by the client indicates an inadequate
understanding of the peak action of NPH insulin and exercise?
a. “The best time for me to exercise is after I eat.”
b. “The best time for me to exercise is after breakfast.”
c. “The best time for me to exercise is mid- to late afternoon.”
d. “The best time for me to exercise is after my morning snack.”
25. A patient is diagnosed with type 1 diabetes. The nurse knows that all of the following are
probable clinical characteristics except:
a. ketosis-prone.
b. little endogenous insulin.
c. obesity at diagnoses.
d. younger than 30 years.
26. A nurse went to a patient’s room to do routine vital signs monitoring and found out that the
patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for:
a. elevated serum bicarbonate and decreased blood pH
b. Signs of hypoglycemia earlier than expected
c. Symptoms of hyperglycemia during the peak time of NPH insulin
d. Sugar in the urine
27. A male nurse is providing a bedtime snack for his patient. This is based on the knowledge
that intermediate-acting insulins are effective for an approximate duration of:
a. 6-8 hours
b. 10-14 hours
c. 14-18 hours
d. 24-28 hours
28. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
a. blurred vision
b. diaphoresis
c. nausea
d. weakness
29. The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should
expect the following symptoms during an assessment, except:
a. hypoglycemia
b. frequent bruising
c. ketonuria
d. dry mouth
30. The tissue area that provides the fastest absorption rate for regular insulin is believed to be
the:
a. abdominal area.
b. anterior thigh.
c. deltoid area.
d. gluteal site.
31. A child with type 1 diabetes mellitus is brought to an emergency room
by the mother, who states that the child has been complaining of
abdominal pain and has a fruity odor of the breath. Diabetic
ketoacidosis is diagnosed. Anticipating the plan of care, the nurse
prepares to administer:
a. Potassium IV infusion
b. NPH insulin IV infusion
c. 5% dextrose IV infusion
d. Normal saline IV infusion
32. If the patient’s blood glucose level is low, but he or she is not exhibiting any symptoms, the
nurse should:
a. give 2 or 3 glucose tablets to the patient
b. change the present IVF to D5 LR
c. double check he glucose level to ensure that it is correct
d. record the blood glucose level
33. Teenager Clarence, an insulin-dependent diabetic, is admitted to the hospital with a diagnosis
of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of
NPH. Every morning Clarence is given NPH insulin at 7:30. Meals are served at 8:30, 12:30, and
6:30. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the
hours of:
a. 11:30 and 1:30
b. 1:30 and 7:30
c. 3:30 and 9:30
d. 5: 30 and 10: 30
34. A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations
and tells the nurse he has type 1 diabetes mellitus. Which of the following actions should the
nurse do first?
a. Inject 1 mg of glucagon subcutaneously
b. Administer 50 mL of 50% glucose I.V
c. Give 4 to 6 oz (118 to 177 mL) of orange juice
d. Give the client four to six glucose tablets
35. The non-diabetic client is admitted for a kidney infection that has now turned septic. The
blood sugars have increased from 150 to 225, what is the best answer to give a family member
who is asking why insulin is used?
a. The client now has type 2 diabetes because of the infection.
b. Insulin is given to control the hypoglycemia.
c. High sugar is common during infection and stress to the body, the insulin will help
lower the sugar until the infection resolves.
d. Insulin administration causes release of the counter- regulatory hormones, thus
decreasing the blood sugar during infection.
36. Possible risk factors associated with type 1 diabetes mellitus include:
a. an autoimmune susceptibility to diabetogenic viruses.
b. environmental factors.
c. the presence of human leukocyte antigen (HLA).
d. all of the above.
37. Clinical manifestations associated with a diagnosis of type 1 diabetes mellitus include all of
the following except:
a. hypoglycemia.
b. hyponatremia.
c. ketonuria.
d. polyphagia.
38. A nurse is assigned to care for a patient who is suspected of having type 2 diabetes mellitus.
Clinical manifestations for which the nurse should assess include:
a. blurred or deteriorating vision.
b. fatigue and muscle cramping.
c. wounds that heal slowly or respond poorly to treatment.
d. all of the above.
39. The nurse should encourage exercise in the management of diabetes, because it:
a. decreases total triglyceride levels.
b. improves insulin utilization.
c. lowers blood glucose.
d. accomplishes all of the above.
40. Self-monitoring of blood glucose is recommended for patients with:
a. abnormal renal glucose thresholds.
b. hypoglycemia without warning symptoms.
c. unstable diabetes.
d. all of the above conditions.
41. The nurse is teaching a client with newly diagnosed Type 1 diabetes about insulin therapy.
Which statement indicates the client needs more teaching concerning insulin therapy?
a. “If I have a headache or start getting nervous, I will drink some orange juice.”
b. “If I pass out at home, a family member should give me a glucagon injection.”
c. “Because I am taking my insulin daily I do not have to adhere to a diabetic diet.”
d. “I will check my blood glucose with my glucometer at least once a day.”
42. The nurse is discussing storage of insulin vials with the client. Which statement indicates the
client understands the teaching concerning the storage of insulin?
a. “I will keep my unopened vials of insulin in the refrigerator.”
b. “I can keep my insulin in the trunk of my car so I will have it at all times.”
c. “It is all right to put my unopened insulin vials in the freezer.”
d. “If I prefill my insulin syringes, I must use them within 1–2 days.”
43. The client diagnosed with Type 2 diabetes is prescribed the sulfonylurea glipizide
(Glucotrol). Which statement by the client would warrant intervention by the nurse?
a. “I have to eat my diabetic diet even if I am taking this medication.”
b. “I will need to check my blood glucose level at least once a day.”
c. “I usually have one glass of wine with my evening meal.”
d. “I do not like to walk every day, but I will if it will help my diabetes.”
44. The client with Type 2 diabetes is admitted into the medical department with a wound on the
left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, “I
don’t want to have to take shots. I take pills at home.” Which statement would be the nurse’s best
response?
a. “If you can’t keep your glucose under control with pills, you must take insulin.”
b. “You should discuss the insulin order with your HCP because you don’t want to take
it.”
c. “You are worried about having to take insulin. I will sit down and we can talk.”
d. “During illness you may need to take insulin to keep your blood glucose level down.”
45. The nurse is caring for the client diagnosed with Type 2 diabetes. The client is complaining
of a headache, jitteriness, and nervousness. Which action should the nurse implement first?
a. Check the client’s serum blood glucose level.
b. Give the client a glass of orange juice.
c. Determine when the last antidiabetic medication was administered.
d. Assess the client’s blood pressure and apical pulse.
46. Which of the following laboratory test/s confirms the diagnosis of diabetes? Select all that
apply.
a. Casual Plasma glucose test 200 mg/dL
b. Fasting plasma glucose 130 mg/dl
c. Oral glucose tolerance test 150 mg/dL
d. HbA1C/glycated hemoglobin 6 %
47. Which of the following conditions lead to hypoglycemia? Select all that apply.
a. error in insulin dose (above intended dose)
b. sepsis
c. surgery
d. increased exercise
e. steroids
f. alcohol
48. Which medication could mask the clinical manifestations of hypoglycemia?
a. Metoprolol
b. Albuterol
c. Spironolactone
d. Prednisone
49. The nurse knows that an intermediate-acting insulin should reach its “peak” in:
a. 1 to 2 hours.
b. 3 to 4 hours.
c. 4 to 12 hours.
d. 16 to 20 hours.
50. A probable candidate for diabetic management with oral antidiabetic agents is the patient
who is:
a. non–insulin-dependent.
b. stable and not prone to ketosis.
c. unable to be managed by diet alone.
d. characterized by all of the above.
Test 2. Discussion
1. Discuss the essential elements in the patient education concerning foot care.
The essential elements in the patient education concerning foot care includes:
2. . Mrs. Evans is a 68-year-old woman with type 2 diabetes who resides in an assisted
living facility. She is on 42 units of NPH insulin every morning.
a. If Mrs. Evans eats her breakfast at 8:00 every morning, when
should she take her insulin?
If Mrs. Evans eats her breakfast at 8:00 every morning, she should
take her insulin not later than 7:30 a.m, because onset is around 30 minutes.
Peaks in about 2 to 3 hours. Therefore, her insulin should usually be taken
about 30 to 60 minutes before her breakfast.
c. What could happen if Mrs. Evans has a busy day and misses
her lunch?
If Mrs. Evans misses a meal; this will result to her blood sugar
dropping further. This can increase her risk of having a hypoglycemic
episode.
Missing a meal would only cause her blood sugar levels to be lower
than normal and medication may drop them even more, which can lead to
hypoglycemia. Hypoglycemia can cause shakiness, passing out, or even
going into a coma.