Chapter 46 Management of Patients With Diabetes
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
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
