Chapter 53
1. The nurse is assessing a group of patients with pre-diabetes. Which of the following should
the nurse include in the teaching plan regarding pre-diabetes?
1. The person with pre-diabetes has an increased risk of heart disease.
2. Individuals with pre-diabetes should limit fluid intake.
3. Patients with pre-diabetes are at increased risk for macular degeneration.
4. The person with pre-diabetes needs insulin to maintain normal blood glucose levels.
Answer: The person with pre-diabetes has an increased risk of heart disease.
Rationale:
The individual with pre-diabetes is at risk for cardiovascular disease. Fluids are not restricted
in pre-diabetes. While individuals with poorly managed diabetes are at risk for retinopathy,
the pre-diabetic is not at risk for diabetes, but does not have or necessarily develop macular
degeneration. A client with pre-diabetes may not always develop diabetes, and not all
diabetics require insulin.
2. The nurse teaches a group of patients that type 1 diabetes involves which of the following
etiologies?
1. Autoimmune disorder
2. Infectious disorder
3. Inflammatory disorder
4. Drug induced disorder
Answer: Autoimmune disorder
Rationale:
Type 1 diabetes, formerly called insulin-dependent or juvenile diabetes, is caused by an
autoimmune process. There is no indication that this type of diabetes is directly caused by
infections, inflammation, or drugs.
3. The nurse is teaching a client about fasting blood glucose levels and an oral glucose
tolerance test. Which of the following should be included in the teaching?
• “You must fast before each of the tests for 8 to 10 hours.”
• “You must fast 8 hours before the fasting blood glucose test, and then eat a large meal, after
which your blood glucose is measured.”
• “The fasting glucose must be 123 or under to be normal.”
• “The 2-hour glucose tolerance test must be over 140 to be considered normal.”
Answer: “You must fast before each of the tests for 8 to 10 hours.”
Rationale:
A fasting blood glucose level requires the client to fast for 8 to 12 hours prior to the test. A
glucose tolerance test involves both a fasting blood glucose level and ingesting a known
quantity of glucose with measurement of the blood glucose at ½, 1, and 2 hours. Fasting for 8
hours and then eating a large meal describes a postprandial blood glucose test. The normal
value for fasting glucose is 60 to 100 mg/dL. The normal result of a 2-hour glucose tolerance
test should be a value of 135/85, triglycerides > 150 mg/dL, low HDL,
abdominal obesity or fasting glucose >100 mg/dL. Triglyceride levels 325 mg/dL. Metabolic
syndrome is present when three or more of the following are present: blood pressure >135/85,
triglycerides > 150 mg/dL, low HDL, abdominal obesity or fasting glucose >100 mg/dL.
Blood pressure 166/84. Metabolic syndrome is present when three or more of the following
are present: blood pressure >135/85, triglycerides > 150 mg/dL, low HDL, abdominal obesity
or fasting glucose >100 mg/dL. Abdominal obesity. Metabolic syndrome is present when
three or more of the following are present: blood pressure >135/85, triglycerides > 150
mg/dL, low HDL, abdominal obesity or fasting glucose >100 mg/dL. Swelling of thighs and
lower extremities. Swelling of lower extremities may be associated with poor venous return,
CHF, hypoalbuminemia, or other disorders.
9. The nurse is teaching a client about prevention and complications of pre-diabetes. Which
of the following should be included in the plan of care?
Select all that apply.
1. Develop an exercise plan with your health care provider.
2. Consume a diet high in fruits and vegetables.
3. Try to attain a target body weight 10% lower than your suggested weight.
4. Increase your calories and decrease your intake of saturated fats.
5. Follow a low-residue diet.
Answer: 1. Develop an exercise plan with your health care provider.
2. Consume a diet high in fruits and vegetables.
Rationale:
Develop an exercise plan with your health care provider. Exercise will help avoid obesity and
attain/maintain normal weight, a risk factor for type 2 diabetes. Consume a diet high in fruits
and vegetables. A Mediterranean diet high in monounsaturated fat, fresh vegetables, and fruit,
as well as exercise, is indicated. Try to attain a target body weight 10% lower than your
suggested weight. Moderate weight loss is indicated, not radical weight loss. Increase your
calories and decrease your intake of saturated fats. Because obesity is a risk factor, caloric
intake is usually decreased, not increased. Follow a low-residue diet. A low-residue diet is
contraindicated; a diet high in fiber moderates blood glucose levels.
10. When caring for a male client with diabetes, the nurse assesses for which of the following
chronic complications of diabetes?
1. Erectile dysfunction
2. Hypoglycemia
3. Icteric sclera
4. Diabetic ketoacidosis
Answer: Erectile dysfunction
Rationale:
Atherosclerotic diseases and poor blood flow are long-term complications of diabetes; this
may include erectile dysfunction, PAD, or coronary heart disease. Icteric sclera are associated
with hepato-biliary disorders, not diabetes. Hypoglycemia and diabetic ketoacidosis are acute
complications of diabetes.
11. When caring for the patient with diabetes, which of the following acute complications
requires immediate intervention?
1. The patient presents with vomiting, abdominal pain, and flushing.
2. The patient complains of burning in the feet and lower extremities.
3. The patient states his vision has decreased over the last several years.
4. The patient’s creatinine is 1.1 mg/dl.
Answer: The patient presents with vomiting, abdominal pain, and flushing.
Rationale:
Vomiting, flushed and dry skin, abdominal pain, and acetone odor to the breath are symptoms
of diabetic ketoacidosis (DKA), which, if untreated, leads to severe dehydration and acidosis.
Burning in the lower extremities may indicate diabetic neuropathy, a chronic complication of
diabetes that can be treated, but not necessarily immediately. Decreased visual acuity is a
chronic complication of diabetes due to retinopathy, macular degeneration, or cataracts. A
creatinine of 1.1 mg/dL is normal and does not represent a complication of diabetes.
12. The nurse teaches the client that he has been placed on an ACE inhibitor to prevent which
of the following complications of diabetes?
1. Kidney damage
2. Hypotensive crisis
3. Neurogenic bladder
4. Infections
Answer: Kidney damage
Rationale:
ACE inhibitors and ARBs prevent the progression of diabetic nephropathy. A hypotensive
crisis is not a component of diabetes; hypertension is more common. A neurogenic bladder
may occur, but an ACE inhibitor will not prevent this. ACE inhibitors are antihypertensive
medications and will not prevent infection.
13. Hypoglycemia is manifested by:
1. Blood glucose level less than 60 mg/dL.
2. Polydipsia.
3. Blood glucose level of 60-75 mg/dL
4. Polyuria.
Answer: Blood glucose level less than 60 mg/dL.
Rationale:
The manifestations of hypoglycemia result from a compensatory autonomic nervous system
(ANS) response and from impaired cerebral function due to a decrease in glucose available
for use by the brain. The manifestations vary, particularly in older adults. The onset is sudden,
and blood glucose is usually less than 45 to 60 mg/dL. Severe hypoglycemia may cause
death.
14. For which of the following clients would the nurse develop a plan of care to discuss risk
factors for developing pre-diabetes and diabetes?
1. Client is a secretary and watches 5 hours of television daily
2. Male who is 5 feet 9 inches tall and weighs 150 pounds
3. 22-year-old female whose hobby is hiking
4. Client prefers to eat chicken rather than pork
Answer: Client is a secretary and watches 5 hours of television daily
Rationale:
A sedentary lifestyle of physical inactivity is associated with the development of pre-diabetes
and type 2 diabetes. The male who is 5 feet 9 inches tall and weighs 150 pounds is at an
appropriate weight. Hiking or physical activity can reduce the risk for diabetes. Eating
chicken rather than pork does not identify the client as at risk for high caloric intake.
15. The community health nurse is performing diabetes screening. Which of the following
groups of individuals is at highest risk for the development of type 2 diabetes?
1. Native Americans
2. Children and adolescents
3. Caucasian Americans
4. Asians living in the Far East
Answer: Native Americans
Rationale:
Groups at higher risk for diabetes include Native Americans, Hispanics, non-Hispanic blacks,
and certain Hawaiians. While children and adolescent diabetes is increasing, evidence shows
these children belong to the same population as the adult group. Caucasians are not in the
highest risk groups.
16. The nurse is providing health education for a group of clients with type 2 diabetes. Which
of the following risk factors should be included in the teaching plan?
1. Overweight
2. Family history
3. Sedentary lifestyle
4. Picky eater
5. Large hip-to-abdomen ratio
Answer: 1. Overweight
2. Family history
3. Sedentary lifestyle
Rationale:
Overweight. The typical risks for developing type 2 diabetes include being overweight.
Family history. The typical risks for developing type 2 diabetes include family members with
diabetes. Sedentary lifestyle. The typical risks for developing type 2 diabetes include a
sedentary lifestyle. Picky eater. There is no indication that being a picky eater is related to
diabetes. Large hip-to-abdomen ratio. The diabetic is typically apple shaped, with a larger
abdomen-to-hip ratio.
17. The public health nurse plans a teaching program for senior citizens on modifying risk
factors in their lifestyle to decrease risk of developing type 2 diabetes mellitus. Which of the
following would the nurse not include in the teaching plan?
1. Genetic predisposition
2. Hypertension
3. Physical inactivity
4. Obesity
Answer: Genetic predisposition
Rationale:
Genetic predisposition, or a history of diabetes in parents or siblings, increases risk for type 2
diabetes mellitus, but this is not a modifiable factor. Modifiable risk factors that increase
cellular resistance to the effect of insulin include hypertension, physical inactivity, and
obesity.
18. When caring for the patient with type 1 diabetes, the nurse includes which of the
following in the plan of care?
1. Administer insulin lispro or aspart immediately prior to the meal.
2. Administer oral hypoglycemic medications ½ hour prior to meals.
3. Observe for hypoglycemia approximately ½ to 1 hour after injecting NPH insulin.
4. Avoid insulin if the patient reports an allergy to sulfa drugs.
Answer: Administer insulin lispro or aspart immediately prior to the meal.
Rationale:
Insulin lispro and aspart are rapid-acting insulins; the meal should be prepared prior to
injecting the insulin. Oral hypoglycemics are not used in the care of type 1 diabetics. The
peak action of NPH, an intermediate-acting insulin, is 4 to 10 hours; the peak action of
insulin is when hypoglycemia is most likely to occur. Sulfonylurea oral agents may cause
cross sensitivity and hypersensitivity in people with sulfa allergy.
19. The nurse should include which of the following in the teaching plan related to diet for
the patient with diabetes?
1. “Select carbohydrates such as whole grains or legumes.”
2. “Eat whenever you feel hungry.”
3. “Do not consume alcoholic beverages.”
4. “Restrict the carbohydrates in your diet.”
Answer: “Select carbohydrates such as whole grains or legumes.”
Rationale:
Complex carbohydrates such as whole grains, legumes, fruits, and those with low glycemic
indices will limit spikes in the blood glucose values. Maintaining a normal weight is
important to the management of diabetes; eating whenever hungry is not consistent with the
diabetic food prescription. Moderate alcohol consumption is permitted, within the dietary
prescription. Restricting carbohydrates to less than 130 grams per day is not recommended.
20. The nurse is responding to a client with diabetes about incorporating an occasional
alcoholic beverage into the meal plan with the provider’s permission. Which of the following
indicates the client understands the teaching?
1. “If I drink alcohol, I should have only one alcohol-containing beverage daily.”
2. “Alcoholic beverages will raise my blood glucose and I will need more insulin.”
3. “If I have a mixed drink, my blood glucose may drop.”
4. “I should take a vitamin supplement on the days I consume alcohol.”
Rationale:
One alcohol-containing beverage for women or two for men is considered a moderate and
acceptable intake of alcohol. Blood glucose is not acutely affected with alcohol consumption;
mixed with carbohydrates such as in a mixed drink, blood glucose levels may rise. Vitamin
supplements do not provide additional medical benefits to diabetics whether they consume
alcohol or not.
21. The nurse teaches the patient with diabetes or pre-diabetes that exercise is especially
important for which of the following reasons?
Select all that apply.
1. Obesity is linked to type 2 diabetes and pre-diabetes.
2. Exercise helps increase insulin receptors and sensitivity to insulin.
3. Exercise enhances the ability of glucose to enter the cells.
4. Individuals with their weight centered in their hips and thighs are at increased risk for
glucose intolerance.
5. Regular exercise will prevent destruction of the beta cells.
Answer: 1. Obesity is linked to type 2 diabetes and pre-diabetes.
2. Exercise helps increase insulin receptors and sensitivity to insulin.
3. Exercise enhances the ability of glucose to enter the cells.
Rationale:
Obesity is linked to type 2 diabetes and pre-diabetes. Obesity is a risk factor for glucose
intolerance and diabetes. Exercise helps increase insulin receptors and sensitivity to insulin.
Exercise increases sensitivity of receptors to insulin and promotes glucose entry into the cells,
improving glycemic control. Exercise enhances the ability of glucose to enter the cells.
Exercise increases sensitivity of receptors to insulin and promotes glucose entry into the cells,
improving glycemic control. Individuals with their weight centered in their hips and thighs
are at increased risk for glucose intolerance. Abdominal obesity, not the “pear” shape, is a
risk factor for metabolic syndrome, which includes impaired glucose tolerance. Regular
exercise will prevent destruction of the beta cells. Regular exercise will not prevent
destruction of the beta cells.
22. When developing a plan of care regarding exercise for clients with diabetes, the nurse
emphasizes which of the following?
1. Plan to carry a carbohydrate-containing snack.
2. Do not exercise if your glucose level is elevated.
3. Avoid aerobic exercises.
4. Exercise must be done every day to be effective.
Answer: Plan to carry a carbohydrate-containing snack.
Rationale:
Exercise promotes entry of glucose into the cell and may precipitate hypoglycemia; the client
should carry a snack when exercising to promptly treat hypoglycemia. There is no indication
that exercise is dangerous with blood glucose values 600 mg/dL, which leads to profound
osmotic diuresis and dehydration. This syndrome may develop more frequently in type 2
diabetics who are ill and have unreplaced fluid losses. While proper diet is important in
diabetes management, dietary indiscretion is not the main cause of HHS. Noncompliance
with self-management is too broad a category to address in a critically ill client.
29. When caring for the client with diabetic ketoacidosis (DKA), the nurse monitors the
blood urea nitrogen (BUN) level for which of the following reasons?
1. Polyuria leads to dehydration and renal impairment.
2. Clients with DKA frequently develop chronic renal failure.
3. The BUN is frequently lower in clients with DKA than clients with HHNS.
4. Acidosis causes the BUN to elevate.
Answer: Polyuria leads to dehydration and renal impairment.
Rationale:
The client with DKA experiences polyuria secondary to osmotic diuresis, causing fluidvolume deficit and decreased renal perfusion that will be reflected in an elevated BUN.
Chronic renal failure is a long-term complication of diabetes, not acute. The BUN will not be
lower in DKA than HHNS; both cause fluid deficit and will result in decreased renal
perfusion. Acidosis does not directly affect the BUN; rather, it develops from lack of insulin
to move glucose into the cell and break down fat for energy.
30. The nurse teaches the patient with diabetes that he is particularly prone to injury that may
lead to amputation of the lower extremities due to which of the following?
Select all that apply.
1. Loss of protective sensation may lead to ulceration and infection.
2. The patient with diabetes is at risk for impaired tissue perfusion secondary to peripheral
arterial disease.
3. Taking insulin increases the likelihood of developing atherosclerotic disease.
4. Patients with hemoglobin A1C greater than 4 are at risk for gangrene.
5. Individuals with diabetes are particularly prone to arthritis.
Answer: 1. Loss of protective sensation may lead to ulceration and infection.
2. The patient with diabetes is at risk for impaired tissue perfusion secondary to peripheral
arterial disease.
Rationale:
Loss of protective sensation may lead to ulceration and infection. Poor blood flow (PAD)
may cause gangrene and decreased sensation may allow an injury to go unobserved and
infection such as osteomyelitis may develop, requiring amputation. The patient with diabetes
is at risk for impaired tissue perfusion secondary to peripheral arterial disease. Clients with
diabetes are prone to atherosclerotic disease and peripheral neuropathy; these process
decrease blood flow to the lower extremities and cause lack of sensation. Taking insulin
increases the likelihood of developing atherosclerotic disease. Taking insulin promotes
glycemic control and decreases risk of vascular complications. Patients with hemoglobin A1C
greater than 4 are at risk for gangrene. The target for hemoglobin A1C should be below 7.
Individuals with diabetes are particularly prone to arthritis. Arthritis is not a risk factor for
injury and PAD leading to amputation.
31. When assessing a 65-year-old patient with diabetes, which of the following assessment
findings requires notification of the health care provider?
1. Cool, mottled discoloration of right great toe
2. Blood glucose value of 70 mg/dL prior to patient eating breakfast
3. Patient states he cannot read teaching materials without eyeglasses
4. Brown discoloration over medial malleous
Answer: Cool, mottled discoloration of right great toe
Rationale:
Cool, mottled skin indicates poor blood flow and indicates underlying atherosclerotic disease.
Blood glucose of 70 mg/dL is normal. A 65-year-old patient is expected to have presbyopia
with lack of accommodation and needs reading glasses. Brown discoloration is symptomatic
of venous, not arterial, insufficiency.
32. When caring for a group of clients with diabetes, the nurse recognizes that which of the
following is at highest risk for peripheral arterial disease?
1. A client whose hemoglobin A1C is 6.9
2. A client diagnosed with pre-diabetes
3. A client who has had a myocardial infarction*
4. A client who states her glucose levels vary from 70 to 125 mg/dL daily
Answer: A client whose hemoglobin A1C is 6.9
Rationale:
The client who has had a myocardial infarction has evidence of atherosclerotic disease, which
strikes the large arteries of the body. A client with pre-diabetes is at higher risk for developing
diabetes. The client with glucose levels of 70 to 125 mg/dL is fairly well controlled and
would not have the same risk as a client with evidence of atherosclerotic disease.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
