1. In preparing a staff in-service presentation about
diabetes mellitus, the nurse includes which information?
a. Diabetes
increases the risk for development of epilepsy.
b. The cure
for diabetes is the administration of insulin.
c. Diabetes
increases the risk for development of cardiovascular disease.
d. Carbohydrate
metabolism is altered in diabetes, but protein metabolism is normal.
ANS: C
Diabetes mellitus is a major risk factor for morbidity and
mortality caused by coronary artery disease, cerebrovascular disease, and
peripheral vascular disease. Insulin is a lifelong treatment for some diabetic
clients. Because insulin regulates the metabolism of carbohydrates, fats, and
protein, abnormalities in insulin production or use alter their metabolism.
DIF: Cognitive Level: Knowledge/Remembering REF: p. 1411
TOP: Client Needs Category: Physiological Integrity
(Physiological Adaptation—Pathophysiology)
MSC: Integrated Process: Nursing Process (Assessment)
2. A client with diabetes asks the nurse why it is necessary
to maintain blood glucose levels no lower than about 60 mg/dL. Which is the
nurse’s best response?
a. “Glucose
is the only fuel used by the body to produce the energy that it needs.”
b. “Your
brain needs a constant supply of glucose because it cannot store it.”
c. “Without
a minimum level of glucose, your body does not make red blood cells.”
d. “Glucose
in the blood prevents the formation of lactic acid and prevents acidosis.”
ANS: B
Because the brain cannot synthesize or store significant
amounts of glucose, a continuous supply from the body’s circulation is needed
to meet the fuel demands of the central nervous system. The other statements
are not accurate.
DIF: Cognitive Level: Comprehension/Understanding REF: p.
1411
TOP: Client Needs Category: Physiological Integrity
(Physiological Adaptation—Pathophysiology)
MSC: Integrated Process: Teaching/Learning
3. The nurse is monitoring a client with hypoglycemia.
Glucagon provides which function?
a. It
enhances the activity of insulin, restoring blood glucose levels to normal more
quickly after a high-calorie meal.
b. It is a
storage form of glucose and can be broken down for energy when blood glucose
levels are low.
c. It
converts excess glucose into glycogen, lowering blood glucose levels in times
of excess.
d. It
prevents hypoglycemia by promoting release of glucose from liver storage sites.
ANS: D
Glycogen is a counterregulatory hormone secreted by the
alpha cells of the pancreas when blood glucose levels are low. The actions of
glycogen that raise blood glucose levels include stimulating the liver to break
down glycogen (glycogenolysis) and forming new glucose from protein breakdown
(gluconeogenesis). The other statements are not accurate descriptions of the
actions of glucagon.
DIF: Cognitive Level: Knowledge/Remembering REF: p. 1412
TOP: Client Needs Category: Physiological Integrity
(Physiological Adaptation—Pathophysiology)
MSC: Integrated Process: Nursing Process (Analysis)
4. A client with untreated diabetes mellitus has polyuria,
is lethargic, and has a blood glucose of 560 mg/dL. The nurse correlates the
polyuria with which finding?
a. Serum sodium,
163 mEq/L
b. Serum
creatinine, 1.6 mg/dL
c. Presence
of urine ketone bodies
d. Serum
osmolarity, 375 mOsm/kg
ANS: D
Hyperglycemia causes hyperosmolarity of extracellular fluid.
This leads to polyuria from an osmotic diuresis. The client’s serum osmolarity
is high. The client’s sodium would be expected to be high owing to dehydration.
Urine ketone bodies and serum creatinine are not related to the polyuria.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Physiological Adaptation—Pathophysiology)
MSC: Integrated Process: Nursing Process (Analysis)
5. A client with diabetes has a serum creatinine of 1.9
mg/dL. The nurse correlates which urinalysis finding with this client?
a. Ketone
bodies in the urine during acidosis
b. Glucose
in the urine during hyperglycemia
c. Protein
in the urine during a random urinalysis
d. White
blood cells in the urine during a random urinalysis
ANS: C
Urine should not contain protein. The presence of proteinuria
in a diabetic client marks the beginning of kidney problems known as diabetic
nephropathy, which progresses eventually to end-stage kidney disease. Decline
in kidney function is assessed with serum creatinine. This client’s creatinine
level is high. The other findings would not be correlated with declining kidney
function.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process:
Nursing Process (Assessment)
6. A young adult client newly diagnosed with type 1 diabetes
mellitus has been taught about self-care. Which statement by the client
indicates a good understanding of needed eye examinations?
a. “At my
age, I should continue seeing the ophthalmologist as I usually do.”
b. “I will
see the eye doctor whenever I have a vision problem and yearly after age 40.”
c. “My
vision will change quickly now. I should see the ophthalmologist twice a year.”
d. “Diabetes
can cause blindness, so I should see the ophthalmologist yearly.”
ANS: D
Diabetic retinopathy is a leading cause of blindness in
North America. All clients with diabetes, regardless of age, should be examined
by an ophthalmologist (rather than an optometrist or optician) at diagnosis and
at least yearly thereafter.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Health Promotion and Maintenance
(Self-Care)
MSC: Integrated Process: Teaching/Learning
7. During assessment of a client with a 15-year history of
diabetes, the nurse notes that the client has decreased tactile sensation in
both feet. Which action does the nurse take first?
a. Document
the finding in the client’s chart.
b. Test
sensory perception in the client’s hands.
c. Examine
the client’s feet for signs of injury.
d. Notify
the health care provider.
ANS: C
Diabetic neuropathy is common when the disease is of long
duration. The client is at great risk for injury in any area with decreased
sensation because he or she is less able to feel injurious events. Feet are
common locations for neuropathy and injury, so the nurse should inspect them
for any signs of injury. After assessing, the nurse should document findings in
the client’s chart. Testing sensory perception in the hands may or may not be
needed. The health care provider can be notified after assessment and
documentation have been completed.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity (Reduction
of Risk Potential—Potential for Complications from Surgical Procedures and
Health Alterations)
MSC: Integrated Process: Nursing Process (Analysis)
8. A client’s father has type 1 diabetes mellitus. The
client asks if she is in danger of developing the disease as well. Which is the
nurse’s best response?
a. “Your
risk of diabetes is higher than that of the general population, but it may not
occur.”
b. “No
genetic risk is associated with the development of type 1 diabetes.”
c. “The
risk for becoming diabetic is 50% because of how it is inherited.”
d. “Female
children do not inherit diabetes, but male children will.”
ANS: A
Risk for type 1 diabetes is determined by inheritance of
genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with
type 1 diabetes are at increased risk for its development. Diabetes (type 1)
seems to require interaction between inherited risk and environmental factors,
so not everyone with these genes develops diabetes. The other statements are
not accurate.
DIF: Cognitive Level: Comprehension/Understanding REF: p.
1416
TOP: Client Needs Category: Physiological Integrity
(Physiological Adaptation—Pathophysiology)
MSC: Integrated Process: Teaching/Learning
9. A client has newly diagnosed diabetes. To delay the onset
of microvascular and macrovascular complications in this client, the nurse
stresses that the client take which action?
a. Control
hyperglycemia.
b. Prevent
hypoglycemia.
c. Restrict
fluid intake.
d. Prevent
ketosis.
ANS: A
Hyperglycemia is a critical factor in the pathogenesis of
long-term diabetic complications. Maintaining tight glycemic control will help
delay the onset of complications. Preventing hypoglycemia and ketosis, although
important, is not as important as maintaining daily glycemic control.
Restricting fluid intake is not part of the treatment plan for clients with
diabetes.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Reduction of Risk Potential—Potential for Complications from Surgical
Procedures and Health Alterations)
MSC: Integrated Process: Teaching/Learning
10. Which client is at greatest risk for undiagnosed
diabetes mellitus?
a. Young,
muscular white man
b. Young
African-American man
c. Middle-aged
Asian woman
d. Middle-aged
American Indian woman
ANS: D
Diabetes is a particular problem among African Americans,
Hispanics, and American Indians. The incidence of diabetes increases in all
races and ethnic groups with age. Being both an American Indian and middle-aged
places a person at highest risk.
DIF: Cognitive Level: Comprehension/Understanding REF: p.
1418
TOP: Client Needs Category: Physiological Integrity
(Physiological Adaptation—Pathophysiology)
MSC: Integrated Process: Nursing Process
(Assessment
Category | ATI |
Release date | 2021-09-14 |
Pages | 28 |
Language | English |
Comments | 0 |
Sales | 0 |
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