1.

A patient with type 1 diabetes has told the nurse that his most recent urine test for
ketones was positive. What is the nurse's 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 patient's 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
patient's 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.

Page 1
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 body's 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 patient's 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 patient's medication
administration record includes the administration of regular insulin three times daily.
Knowing that the patient's lunch tray will arrive at 11:45, when should the nurse
administer the patient's insulin?
A) 10:45
B) 11:15
C) 11:45
D) 11:50
Ans: B
Feedback:
Regular insulin is usually administered 20ñ30 min before a meal. Earlier administration
creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.

Page 2
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
ìsick day rules.î 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.

Page 3
 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
individual's 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
child's 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) Nonñinsulin-dependent diabetes
D) Prediabetes
Ans: A
Feedback:
Beta cell destruction is the hallmark of type 1 diabetes. Nonñinsulin-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.

Page 4
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) ìThe tissues in your body are resistant to the action of insulin, making the glucose
levels in your blood increase.î
B) ìDamage to your pancreas causes an increase in the amount of glucose that it
releases, and there is not enough insulin to control it.î
C) ìThe amount of glucose that your body makes overwhelms your pancreas and
decreases your production of insulin.î
D) ìDestruction of special cells in the pancreas causes a decrease in insulin
production. Glucose levels rise because insulin normally breaks it down.î
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
ìmakeî 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) ìI've always been a fan of sweet foods, but lately I'm turned off by them.î
B) ìLately, I drink and drink and can't seem to quench my thirst.î
C) ìNo matter how much sleep I get, it seems to take me hours to wake up.î
D) ìWhen I went to the washroom the last few days, my urine smelled odd.î
Ans: B
Feedback:
Classic clinical manifestations of diabetes include the ìthree Psî: polyuria, polydipsia,
and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not
suggestive of diabetes.

Page 5
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) ìI read that a pancreas transplant will provide a cure for my diabetes.î
B) ìI will take my oral antidiabetic agents when my morning blood sugar is high.î
C) ìI will make sure to follow the weight loss plan designed by the dietitian.î
D) ìI will make sure I call the diabetes educator when I have questions about my
insulin.î
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 ADA's 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.

Page 6
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
patient's 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 patient's 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 patient's first hemoglobin A1C result after discharge.
Ans: B
Feedback:
Nurses should assess the patient's 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.

Page 7
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
complicationsóespecially foot and eye problemsóassociated 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.

Page 8
18. A diabetic educator is discussing ìsick day rulesî with a newly diagnosed type 1
diabetic. The educator is aware that the patient will require further teaching when the
patient states what?
A) ìI will not take my insulin on the days when I am sick, but I will certainly check
my blood sugar every 2 hours.î
B) ìIf I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six
to eight times a day.î
C) ìI will call the doctor if I am not able to keep liquids in my body due to vomiting
or diarrhea.î
D) ìI will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in
my urine.î
Ans: A
Feedback:
The nurse must explanation the ìsick day rulesî 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 one's 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.

Page 9
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.

Page 10
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 patient's blood sugar levels.
C) The patient has likely overestimated her ability to control her diabetes using
nonpharmacologic measures.
D) The patient's 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 patient's need for insulin is unrelated to the
action of bile, the patient's 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 nurse's best response?
A) ìResearch has shown that diabetic neuropathy is caused by fluctuations in blood
sugar that have gone on for years.î
B) ìThe cause is not known for sure but it is thought to have something to do with
ketoacidosis.î
C) ìThe cause is not known for sure but it is thought to involve elevated blood
glucose levels over a period of years.î
D) ìResearch has shown that diabetic neuropathy is caused by a combination of
elevated glucose levels and elevated ketone levels.î
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.

Page 11
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 patient's daily dose
of metformin, the nurse should prioritize which of the following assessments?
A) Monitoring the patient's neutrophil levels
B) Assessing the patient for signs of impaired liver function
C) Monitoring the patient's level of consciousness and behavior
D) Reviewing the patient's creatinine and BUN levels
Ans: D
Feedback:
Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor
the patient's 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 patient's Medic Alert bracelet indicates that the patient has type
1 diabetes and the patient's 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 patient's condition.

Page 12
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 ìsurvival skillsî 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 hypo- and hyperglycemia. The other listed topics are valid points for
education, but are not components of the patient's immediate ìsurvival skillsî 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 ìgoes bad.î What
would be the nurse's best answer?
A) ìIf you are going to use up the vial within 1 month it can be kept at room
temperature.î
B) ìIf a vial of insulin will be used up within 21 days, it may be kept at room
temperature.î
C) ìIf a vial of insulin will be used up within 2 weeks, it may be kept at room
temperature.î
D) ìIf a vial of insulin will be used up within 1 week, it may be kept at room
temperature.î
Ans: A
Feedback:
If a vial of insulin will be used up within 1 month, it may be kept at room temperature.

Page 13
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
nurse's priority action?
A) Ensure that the patient understands the basic pathophysiology of diabetes.
B) Identify the patient's body mass index.
C) Teach the patient ìsurvival skillsî for diabetes.
D) Assess the patient's readiness to learn.
Ans: D
Feedback:
Before initiating diabetes education, the nurse assesses the patient's (and family's)
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 (2.8 mmol/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.

Page 14
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 patient's initial phase of treatment?
A) Monitoring the patient for dysrhythmias
B) Maintaining and monitoring the patient's fluid balance
C) Assessing the patient's 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 ìcheck-insî 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.

Page 15
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 patient's knowledge of self-care skills. What would be
the most appropriate way for the educator to assess the patient's 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 patient's family what he typically eats.
D) Ask the patient to describe a typical day's food intake.
Ans: B
Feedback:
Reviewing the patient's actual food intake is the most accurate method of gauging the
patient's 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 nurse's 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
patient's liver function is not likely affected. There is no indication for the use of a fluid
challenge.

Page 16
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 ìflu bug.î The nurse tells him
to take his regular dose of insulin. What else should the nurse tell the patient?
A) ìMake sure to stick to your normal diet.î
B) ìTry to eat small amounts of carbs, if possible.î
C) ìEnsure that you check your blood glucose every hour.î
D) ìFor now, check your urine for ketones every 8 hours.î
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.

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