NCLEX RN Diabetes Mellitus Nursing Test Bank (QUESTIONS AND CORRECT ANSWERS) 2023

1. A patient has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include? A. The alcohol could cause pancreatic disease. B. The alcohol could cause serious liver disease. C. The alcohol could predispose you to hypoglycemia. D. The alcohol could predispose you to hyperglycemia. Correct Answer: C. The alcohol could predispose you to hypoglycemia. Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client. When the client drinks alcohol, the alcohol can inhibit the liver’s ability to release glucose into the blood. This can be particularly significant for people on stronger medication such as insulin because it can mean that the liver is not able to release enough glycogen to keep the blood glucose levels from going too low under the influence of insulin in the body. Option A: Alcohol can cause pancreatic disease, but the client’s pancreas is not producing any insulin currently. Alcohol abuse is a well- recognized association of both acute and chronic pancreatitis, with repeated attacks of alcohol-induced acute pancreatic necroinflammation leading to chronic disease. The risk of developing pancreatitis increases with increased consumption of alcohol. Option B: Alcohol can cause liver disease, but the more immediate concern is hypoglycemia. Moderate amounts of alcohol may cause blood sugar to rise, excess alcohol can actually decrease your blood sugar level – which can be dangerous for people with T1D. Option D: People with T1D should only drink while eating food. Beer and sweet wine contain carbohydrates and may raise blood sugar. People may overeat when drinking alcohol which also can increase your BG. 2. A doctor orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication? A. When the client is eating B. Thirty minutes before meals C. Fifteen minutes before meals D. When the meal trays arrive on the floor Correct Answer: A. When the client is eating The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia. Insulin lispro is a new type of insulin. It starts working sooner than other insulin types. It also reaches peak activity faster and goes away sooner. Option B: If taking Regular insulin or longer-acting insulin, the client should generally take it 15 to 30 minutes before a meal. Short-acting, such as Regular (R) insulin, starts working within 30 minutes and lasts about 5 to 8 hours. Option C: Each type of insulin works at a different speed and lasts for a different length of time. Quick-acting, such as insulin lispro (Humalog), begins to work very quickly (5 to 15 minutes) and lasts for 3 to 4 hours. Option D: It must be given when the client is eating, not when the meal trays arrive on the floor. Rapid-acting insulin analogs should be injected within 15 min before a meal or immediately after a meal. The most commonly recommended interval between injection of short- acting (regular) insulin and a meal is 30 min. 3. Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client’s additional insulin vials are not refrigerated. What is the best action by the nurse at this time? A. Instruct the client to label each vial with the date when opened. B. Tell the client there is no need to keep additional vials. C. Have the client place the insulin vials in the refrigerator. D. Have the client discard the vials. Correct Answer: C. Have the client place the insulin vials in the refrigerator. Vials not in use should be refrigerated to preserve drug potency. Vials of insulin not in use should be refrigerated. Extreme temperatures (<36 or >86°F, <2 or >30°C) and excess agitation should be avoided to prevent loss of potency, clumping, frosting, or precipitation. Option A: Writing the date of opening on the vial is good practice, but does not address the need to refrigerate additional vials. Specific storage guidelines provided by the manufacturer should be followed. Insulin in use may be kept at room temperature to limit local irritation at the injection site, which may occur when cold insulin is used. Option B: The client should always have additional vials of insulin available. The patient should always have available a spare bottle of each type of insulin used. Although an expiration date is stamped on each vial of insulin, a loss in potency may occur after the bottle has been in use for >1 month, especially if it was stored at room temperature. Option D: There is no need to discard the vials. If uncertain about the potency of a vial of insulin, the individual should replace the vial in question with another of the same type. The person administering insulin should inspect the bottle before each use for changes (i.e., clumping, frosting, precipitation, or change in clarity or color) that may signify a loss in potency. 4. During the morning rounds, Nurse AJ accompanied the physician in every patient’s room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician? A. Use Humalog insulin for sliding scale coverage. B. Metformin (Glucophage) 1000 mg per day in divided doses. C. Administer regular insulin 30 minutes prior to meals. D. Lantus insulin 20U BID. Correct Answer: D. Lantus insulin 20U BID. Lantus insulin is usually prescribed once a day so an order for BID dosing should be validated with the physician. Lantus is designed to give a steady level of insulin over 24 hours, even when you are not eating such as between meals and overnight. This helps keep blood glucose levels consistent during the day and at night. Option A: Humalog insulin can be prescribed for sliding scale coverage. The use of Humalog includes correcting the high blood sugar levels just before mealtime. For this aspect, a sliding scale is used to identify the needed amount of insulin that the patients must take. Option B: Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day. Metformin is an oral medication typically dosed from 500 to 2550 mg per day and administered with a meal to decrease GI upset. The daily dose is often titrated weekly in increments of 500 mg or 850 mg to reduce this risk. Option C: Regular insulin is administered 30 minutes before meals. Insulin, regular when administered subcutaneously, should be injected 30 to 40 minutes before each meal. Avoid cold injections. The injection is in the buttocks, thighs, arms, or abdomen; it is necessary to rotate injection sites to avoid lipodystrophy. 5. Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement? A. "My cells have increased their receptors, but there is enough insulin." B. "My peripheral cells have increased sensitivity to insulin." C. "My beta cells cannot produce enough insulin for my cells." D. "My cells cannot use the insulin my pancreas makes." Correct Answer: D. “My cells cannot use the insulin my pancreas makes.” With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. T2DM is an insulin-resistance condition with associated beta-cell dysfunction. Initially, there is a compensatory increase in insulin secretion, which maintains glucose levels in the normal range. As the disease progresses, beta cells change, and insulin secretion is unable to maintain glucose homeostasis, producing hyperglycemia. Option A: There is a decrease, not an increase, in receptor sites with type 2 diabetes. Most of the patients with T2DM are obese or have a higher body fat percentage, distributed predominantly in the abdominal region. This adipose tissue itself promotes insulin resistance through various inflammatory mechanisms, including increased FFA release and adipokine dysregulation. Option B: Peripheral cells have a decreased, not an increased, sensitivity to insulin. The beta cells continue to produce insulin with type 2 diabetes. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM. Option C: Type 1 diabetes mellitus (T1DM) accounts for 5% to 10% of DM and is characterized by autoimmune destruction of insulin- producing beta cells in the islets of the pancreas. As a result, there is an absolute deficiency of insulin.