Chapter 47 Evolve

3. The nurse interviews a patient with a history of type 2 diabetes mellitus, chronic bronchitis, and
osteoarthritis who has a fasting blood glucose of 154 mg/dL. Which patient medication may be
responsible for the elevated blood glucose level?
Prednisone Correct
Prednisone is a corticosteroid that may cause glucose intolerance in susceptible patients by increasing
gluconeogenesis and insulin resistance. Insulin (e.g., glargine) and metformin (an oral hypoglycemic
agent) decrease blood glucose lev els. Acetaminophen has a glucose-lowering effect.
10. A patient’s recent medical history is indicative of diabetes insipidus. The nurse would anticipate
teaching the patient about which diagnostic test?
Water deprivation test Correct
A water deprivation test is used to diagnosis if polyuria is related to diabetes insipidus. Glucose tests and
thyroid tests are not directly related to the diagnosis of diabetes insipidus.
11. The nurse is teaching a patient who is scheduled for an oral glucose tolerance test. Which
statement indicates further teaching is required?
“I will fast for at least 8 hours before the test.”
“Ingesting caffeine and smoking may alter the test results.”
“The results of this test will indicate my blood sugar control over the last 3 months.” Correct
“Blood samples will be taken at intervals after I drink a sample of glucose solution.” Incorrect
Glycosylated hemoglobin measures the amount of glucose bound to hemoglobin over the past 3 months,
not an oral glucose tolerance test. An oral glucose tolerance test requires nothing by mouth for 8 to12
hours. Caffeine and smoking may influence test results. After ingesting the oral glucose sample, blood is
drawn after 30-, 60-, and 120-minute intervals.

Chapter 48 Evolve
1. A patient admitted with type 2 diabetes asks the nurse what “type 2” means. What is the most
appropriate response by the nurse?
“With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased.”
Correct
In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and/or the cells of the body
become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally
dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with
type 1 diabetes mellitus.
2. The nurse caring for a patient hospitalized with diabetes mellitus would look for which
laboratory test result to obtain information on the patient’s past glucose control?
 Glycosylated hemoglobin level Correct
A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs).
When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of
the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control
over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is
unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation
is probably currently occurring. The fasting glucose level only indicates current glucose control.
3. The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of
blood glucose (SMBG). During evaluation of the patient’s technique, the nurse identifies a need for
additional teaching when the patient does what?
Chooses a puncture site in the center of the finger pad Correct
Washes hands with soap and water to cleanse the site to be used
Warms the finger before puncturing the finger to obtain a drop of blood
Tells the nurse that the result of 110 mg/dL indicates good control of diabetes
The patient should select a site on the sides of the fingertips, not on the center of the finger pad because
this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the
finger, and knowing the results that indicate good control all show understanding of the teaching.
4. The nurse is assigned to the care of a patient diagnosed with type 2 diabetes. In formulating a
teaching plan that encourages the patient to actively participate in management of the diabetes,
what should be the nurse’s initial intervention?
Assess patient’s perception of what it means to have diabetes. Correct
For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the
nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current
knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of
the patient’s care will not facilitate the patient’s health.
5. The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What
information is appropriate for the nurse to include?
Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of
the eyes, kidneys, and skin. Correct
Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy.
When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to
diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to
cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric
emptying result from microangiopathy and neuropathy.
6. The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom
reported by the patient correlates with the diagnosis?
Excessive thirst Correct
The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and
polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2
diabetes, but are not classic manifestations.
7. A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The
nurse instructs the patient to only drink water after what time?
Midnight before the test Correct
Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason,
the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories
after midnight.
8. A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level
of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern
would the nurse expect to find?
Kussmaul respirations Correct
In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and
carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central
apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing,
which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with
ketoacidosis.
9. The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as
part of the initial management of diabetes. The nurse would encourage the patient to limit intake of
which foods to help reduce the percent of fat in the diet?
Cheese Correct
Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit,
and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.
10. The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes.
Which result reflects the expected pattern accompanying macrovascular disease as a complication
of diabetes?
Increased triglyceride levels Correct
Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They
include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are
associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are
positive in relation to atherosclerosis development.
11. The nurse has taught a patient admitted with diabetes principles of foot care. The nurse
evaluates that the patient understands the principles of foot care if the patient makes what
statement?
“I should look at the condition of my feet every day.” Correct
Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection
and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water
temperature should be tested with the hands first.
12. The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose
level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time
related to the insulin’s peak action?
10:30 PM to 1:30 AM Correct
Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia
between 10:30 PM and 1:30 AM. Rapid-acting insulin’s onset is between 10 and 30 minutes with peak
action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting
insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.
13. A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and
being anxious but does not have a portable blood glucose monitor present. Which action should the
nurse advise her to take?
Eat 15 g of simple carbohydrates. Correct
When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing,
she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also
be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not
allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin
would further decrease her blood glucose.
14. A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has
a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present.
What nursing action is appropriate at this time?
Cardiac monitoring to detect potassium changes Correct
This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring
will be needed because of the changes in the potassium level related to fluid and insulin therapy and the
osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and
exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not
affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because
this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to
avoid fluid overload during fluid replacement.
15. The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should
the nurse teach the patient to best explain how this medication works?
Reduces glucose production by the liver and enhances insulin sensitivity
Correct
Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue’s insulin
sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase
inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists
increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric
emptying.
16. The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control blood
glucose. The nurse knows the patient understands when the patient elicits which exercise plan?
“I will take a brisk 30-minute walk 5 days per week and do resistance training three times a
week.” Correct
The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days
per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and
teaching are light activity, and running is considered vigorous activity.
17. A patient with diabetes mellitus who has multiple infections every year needs a mitral valve
replacement. What is the most important preoperative teaching the nurse should provide to
prevent a cardiac infection postoperatively?
Obtain comprehensive dental care. Correct
A person with diabetes is at high risk for postoperative infections. The most important preoperative
teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive
dental care because the risk of septicemia and infective endocarditis increases with poor dental health.
Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep
breathing with splinting would be important for any type of surgery but are not the priority for this patient
with mitral valve replacement.
18. The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient
meets the diagnostic criteria for diabetes mellitus?
A 48-yr-old woman with a hemoglobin A1C of 8.4% Correct
A 58-yr-old man with a fasting blood glucose of 111 mg/dL
A 68-yr-old woman with a random plasma glucose of 190 mg/dL
A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL
Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C of 6.5% or greater, fasting plasma
glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an
oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random
plasma glucose of 200 mg/dL or greater.
19. The nurse teaches a patient recently diagnosed with type 1 diabetes mellitus about insulin
administration. Which statement by the patient requires an intervention by the nurse?
“I will discard any insulin bottle that is cloudy in appearance.” Correct
Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine
hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient
during self-injections. Insulin vials that the patient is currently using may be left at room temperature for
up to 4 weeks unless the room temperature is higher than 86°F (30°C) or below freezing
20. The nurse instructs a patient with diabetes mellitus about a healthy eating plan. Which
statement made by the patient indicates that teaching was successful?
 “I may have a hypoglycemic reaction if I drink alcohol on an empty stomach.” Correct
Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia.
Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food
selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat
intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is
recommended for the general population and for patients with diabetes mellitus. High-protein diets are
not recommended for weight loss.
21. Which patient with type 1 diabetes mellitus would be at the highest risk for developing
hypoglycemic unawareness?
A 73-yr-old patient who takes propranolol (Inderal)
Correct
Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and
symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness.
Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion
of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-
adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
22. The nurse is teaching a patient with type 2 diabetes mellitus how to prevent diabetic
nephropathy. Which statement made by the patient indicates that teaching has been successful?
“I can help control my blood pressure by avoiding foods high in salt.” Correct
Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels
that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include
hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are
screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a
serum creatinine is also needed.

23. A patient is admitted with diabetes mellitus, malnutrition cellulitis, and a potassium level of 5.6
mEq/L. The nurse understands that what could be contributing factors for this laboratory result
(select all that apply.)?
The level may be increased as a result of dehydration that accompanies hyperglycemia. Correct
The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. Correct
The level is consistent with renal insufficiency that can develop with renal nephropathy. Correct
This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.
The additional stress of cellulitis may lead to an increase in the patient’s serum glucose levels.
Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have
difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential
for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to
compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium
retention. Thus, it is not a contributing factor to this patient’s potassium level. The elevated potassium
level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.