8/30/24, 10:55 Exam View - Chapter 59 - Ignatavicius: Medical-Surgical Nursing,
AM 10th Edi…
Chapter 59: Concepts of Care for Patients With Diabetes Mellitus Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glucose levels no
lower than about 60 mg/dL (3.3 mmol/L)?” How would the nurse respond?
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 nurse would want to educate the patient to prevent
hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of
red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Hypoglycemia
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
2. The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this
health condition?
a. Hypotension
b. Hyperthyroidism
c. Abdominal obesity
d. Hypoglycemia
ANS: C
The client at risk for metabolic syndrome typically has hypertension, abdominal obesity, hyperlipidemia, and hyperglycemia.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Metabolic syndrome, Assessment
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
3. After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client’s
understanding. Which statement made by the client indicates a correct understanding of the need for eye
examinations?
a. “At my age, I should continue seeing the ophthalmologist as I usually do.”
b. “I will see the eye doctor when I have a vision problem and yearly after age 40.”
c. “My vision will change quickly. 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: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Health screening
MSC: Client Needs Category: Health Promotion and Maintenance
4. A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What
action would the nurse take first?
a. Document the finding in the client’s chart.
b. Assess tactile sensation in the client’s hands.
c. Examine the client’s feet for signs of injury.
d. Notify the primary 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 decreas
sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurs
would inspect them for any signs of injury. After assessment, the nurse would document findings in the client’s chart. Testing
sensory perception in the hands may or may not be needed. The primary health care provider can be notified after assessment and
documentation have been completed.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Diabetes mellitus, Complications
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
about:bl 1/
,8/30/24, 10:55 Exam View - Chapter 59 - Ignatavicius: Medical-Surgical Nursing,
AM 10th Edi…
Copyright © 2021, Elsevier Inc. All rights reserved.
about:bl 2/
, 8/30/24, 10:55 Exam View - Chapter 59 - Ignatavicius: Medical-Surgical Nursing,
AM 10th Edi…
5. A nurse cares for a client who has a family history of diabetes mellitus. The client states, “My father has type 1 diabetes
mellitus. Will I develop this disease as well?” How would the nurse respond?
a. “Your risk of diabetes is higher than the general population, but it may
not occur.”
b. “No genetic risk is associated with the development of type 1 diabetes mellitus.”
c. “The risk for becoming a diabetic is 50% because of how it is inherited.”
d. “Female children do not inherit diabetes mellitus, 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 interactio n between
inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accura
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Genetics
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
6. A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client’s plan
of care to delay the onset of microvascular and macrovascular complications?
a. “Maintain tight glycemic control and prevent hyperglycemia.”
b. “Restrict your fluid intake to no more than 2 L a day.”
c. “Prevent hypoglycemia by eating a bedtime snack.”
d. “Limit your intake of protein to prevent ketoacidosis.”
ANS: A
Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control
wil help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for patients with diabetes.
Preventi hypoglycemia and ketosis, although important, is not as important as maintaining daily glycemic control.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Hyperglycemia
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
7. A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?
a. A 19-year-old Caucasian
b. A 22-year-old African American
c. A 44-year-old Asian American
d. A 58-year-old American Indian
ANS: D
Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes
increase in all races and ethnic groups with age. Being both an American Indian and middle age places this patient at highest
risk.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Diabetes mellitus, Risk factors
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
8. A nurse teaches a patient about self-monitoring of blood glucose levels. Which statement would the nurse include in this
client’s teaching to prevent bloodborne infections?
a. “Wash your hands after completing each test.”
b. “Do not share your monitoring equipment.”
c. “Blot excess blood from the strip with a cotton ball.”
d. “Use gloves when monitoring your blood glucose.”
ANS: B
Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis
in particular can survive in a dried state for about a week. The client would be taught to avoid sharing any equipment, including t
lancet holder. The client would also be taught to wash his or her hands before testing. He or she would not need to blot excess
blood away from the strip or wear gloves.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Infection control
MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
9. A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse
include in this client’s teaching?
a. “Change positions slowly when you get out of bed.”
b. “Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).”
c. “If you miss a dose of this drug, you can double the next dose.”
d. “Discontinue the medication if you develop a urinary infection.”
ANS: B
NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not
applicable to glipizide.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Drug therapy
MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
about:bl 3/
AM 10th Edi…
Chapter 59: Concepts of Care for Patients With Diabetes Mellitus Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glucose levels no
lower than about 60 mg/dL (3.3 mmol/L)?” How would the nurse respond?
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 nurse would want to educate the patient to prevent
hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of
red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Hypoglycemia
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
2. The nurse is assessing a client for risk of developing metabolic syndrome. Which risk factor is associated with this
health condition?
a. Hypotension
b. Hyperthyroidism
c. Abdominal obesity
d. Hypoglycemia
ANS: C
The client at risk for metabolic syndrome typically has hypertension, abdominal obesity, hyperlipidemia, and hyperglycemia.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Metabolic syndrome, Assessment
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
3. After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client’s
understanding. Which statement made by the client indicates a correct understanding of the need for eye
examinations?
a. “At my age, I should continue seeing the ophthalmologist as I usually do.”
b. “I will see the eye doctor when I have a vision problem and yearly after age 40.”
c. “My vision will change quickly. 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: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Health screening
MSC: Client Needs Category: Health Promotion and Maintenance
4. A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. What
action would the nurse take first?
a. Document the finding in the client’s chart.
b. Assess tactile sensation in the client’s hands.
c. Examine the client’s feet for signs of injury.
d. Notify the primary 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 decreas
sensation because he or she is less able to feel injurious events. Feet are common locations for neuropathy and injury, so the nurs
would inspect them for any signs of injury. After assessment, the nurse would document findings in the client’s chart. Testing
sensory perception in the hands may or may not be needed. The primary health care provider can be notified after assessment and
documentation have been completed.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Diabetes mellitus, Complications
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
about:bl 1/
,8/30/24, 10:55 Exam View - Chapter 59 - Ignatavicius: Medical-Surgical Nursing,
AM 10th Edi…
Copyright © 2021, Elsevier Inc. All rights reserved.
about:bl 2/
, 8/30/24, 10:55 Exam View - Chapter 59 - Ignatavicius: Medical-Surgical Nursing,
AM 10th Edi…
5. A nurse cares for a client who has a family history of diabetes mellitus. The client states, “My father has type 1 diabetes
mellitus. Will I develop this disease as well?” How would the nurse respond?
a. “Your risk of diabetes is higher than the general population, but it may
not occur.”
b. “No genetic risk is associated with the development of type 1 diabetes mellitus.”
c. “The risk for becoming a diabetic is 50% because of how it is inherited.”
d. “Female children do not inherit diabetes mellitus, 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 interactio n between
inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accura
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Genetics
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
6. A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement would the nurse include in this client’s plan
of care to delay the onset of microvascular and macrovascular complications?
a. “Maintain tight glycemic control and prevent hyperglycemia.”
b. “Restrict your fluid intake to no more than 2 L a day.”
c. “Prevent hypoglycemia by eating a bedtime snack.”
d. “Limit your intake of protein to prevent ketoacidosis.”
ANS: A
Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight glycemic control
wil help delay the onset of complications. Restricting fluid intake is not part of the treatment plan for patients with diabetes.
Preventi hypoglycemia and ketosis, although important, is not as important as maintaining daily glycemic control.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Hyperglycemia
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
7. A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?
a. A 19-year-old Caucasian
b. A 22-year-old African American
c. A 44-year-old Asian American
d. A 58-year-old American Indian
ANS: D
Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence of diabetes
increase in all races and ethnic groups with age. Being both an American Indian and middle age places this patient at highest
risk.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Diabetes mellitus, Risk factors
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
8. A nurse teaches a patient about self-monitoring of blood glucose levels. Which statement would the nurse include in this
client’s teaching to prevent bloodborne infections?
a. “Wash your hands after completing each test.”
b. “Do not share your monitoring equipment.”
c. “Blot excess blood from the strip with a cotton ball.”
d. “Use gloves when monitoring your blood glucose.”
ANS: B
Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis
in particular can survive in a dried state for about a week. The client would be taught to avoid sharing any equipment, including t
lancet holder. The client would also be taught to wash his or her hands before testing. He or she would not need to blot excess
blood away from the strip or wear gloves.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Infection control
MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
9. A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement would the nurse
include in this client’s teaching?
a. “Change positions slowly when you get out of bed.”
b. “Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).”
c. “If you miss a dose of this drug, you can double the next dose.”
d. “Discontinue the medication if you develop a urinary infection.”
ANS: B
NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not
applicable to glipizide.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Drug therapy
MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
about:bl 3/
