Chapter 50: Diabetes and Hypoglycemia
Linton: Medical-Surgical Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse explains that type 1 diabetes mellitus is a disease in which the body does not
produce enough insulin. What is the reason that the blood glucose is elevated?
a. Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth
hormone) levels
b. Malfunction of the glycogen-storing capabilities of the liver
c. Destruction of the beta cells in the pancreas
d. Insulin resistance of the receptor cells in the muscle tissue
ANS: C
Type 1 diabetes mellitus is a disease in which the pancreas does not produce adequate
insulin because of the destruction of beta cells.
DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 2
TOP: Type 1 Diabetes Mellitus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. A patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take
a pill instead of insulin. The nurse explains that in type 2 diabetes mellitus, the body still
makes insulin. What other information is pertinent for the nurse to relay?
a. Overweight and underactive people cannot simply use the insulin produced.
b. Metabolism is slowed in some people, so they have to take a pill to speed up their
metabolism.
c. Sometimes the autoimmune system works against the action of the insulin.
d. The cells become resistant to the action of insulin. Pills are given to increase the
sensitivity.
ANS: D
Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of
insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more
sensitive.
DIF: Cognitive Level: Comprehension REF: pp. 981-982 OBJ: 2
TOP: Type 2 Diabetes Mellitus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
3. A patient tells a nurse that she eats “huge” amounts of food but stays hungry most of the
time. What should the nurse explain as the cause of hunger experienced by persons with
type 1 diabetes?
a. Excess amount of glucose
b. Need for additional calories to correct the increased metabolism
c. Fact that the cells cannot use the blood glucose
d. Need for exercise to stimulate insulin secretion
ANS: C
, The cells cannot use the glucose without insulin, so the patient with diabetes still feels
hungry even though abundant glucose is circulating in the blood.
DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 1
TOP: Hunger in the Patient with Diabetes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. What does the lack of insulin in patients with type 1 diabetes cause that increases the risk
for cardiovascular disorders?
a. High glucose levels that irritate and shrink the vessels
b. Inadequate metabolism of proteins, which causes ketosis
c. Increased fatty acid levels
d. Increased metabolism of ketones, which causes hypertension
ANS: C
The increase in fatty acid levels causes an increase in the level of triglycerides and an
attendant rise in low-density lipoprotein levels.
DIF: Cognitive Level: Knowledge REF: pp. 968-969 OBJ: 1
TOP: Diabetes: Complications KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
5. The self-care goal of a patient with diabetes is to keep the blood sugar within normal
limits. What causes hyperglycemia to occur?
a. Blood glucose levels rise, stimulating the production of insulin.
b. Insulin conversion of glycogen to glucose is inhibited.
c. The body responds to glucose-starved tissues by changing stored glycogen into
glucose.
d. Glycogen is unable to be stored in the liver and muscles.
ANS: C
The hypothalamus is receiving a message that the cells need glucose, so it responds by
adding more glucose to the already overburdened blood.
DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 1
TOP: Hyperglycemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. A young patient complains that diabetes is causing her to “have no life at all. It’s too
hard.” What is the most helpful response by the nurse?
a. “Yes, you must make some sacrifices.”
b. “It’s hard, but with significant alterations in your lifestyle, you can live a long
life.”
c. “What’s hard about exercise, diet, and medicine?”
d. “Let’s talk about what makes it so hard.”
ANS: D
Involving the patient in decisions about how she will cope with her diabetes will make the
goals more realistic and personal, which will give her a greater chance of success in
meeting them.
, DIF: Cognitive Level: Application REF: p. 990 OBJ: 7
TOP: Diabetes Lifestyle KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
7. When a patient with type 2 diabetes says, “Why in the world are they looking at my
hemoglobin? I thought my problem was with my blood sugar.” What should the nurse
explain about the level of hemoglobin A1c?
a. Shows how a high level of glucose can cause a significant drop in the hemoglobin
level
b. Shows what the glucose level has done during the past 3 months
c. Indicates a true picture of the patient’s nutritional state
d. Reflects the effect of a high level of glucose on the ability to produce red blood
cells (RBCs)
ANS: B
By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose
can be evaluated for the past 3 months because the glucose stays bound to the hemoglobin
for the life of the RBC.
DIF: Cognitive Level: Comprehension REF: p. 983 OBJ: 1
TOP: Hemoglobin A1c: Glycosylated Hemoglobin Level
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. A patient with type 2 diabetes shows a blood sugar reading of 68 at 6 AM. What action
should the nurse implement based on the reading of 72 mg/dL?
a. Notify the charge nurse of the reading.
b. Give regular insulin per a sliding scale.
c. Give him 8 oz of skim milk.
d. Administer the oral glucose tablet.
ANS: C
The patient is hypoglycemic and needs an immediate source of glucose, such as milk or
orange juice. The oral hypoglycemic agent will not work quickly enough. The charge
nurse can be notified later. Giving insulin per a sliding scale would lower the blood sugar
level.
DIF: Cognitive Level: Application REF: p. 991 OBJ: 6
TOP: Hypoglycemic Reaction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. A nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this
is a life-threatening condition. What will DKA result in?
a. Disorder of carbohydrates, fats, and proteins metabolism
b. Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream
c. Dangerously elevated pH and bicarbonate levels in the blood
d. Severe hypoglycemia, which can result in coma and convulsions
ANS: A
DKA is mainly related to the use of fat as an energy source because of an inability of the
body to use glucose. The metabolism of fat produces ketones.
, DIF: Cognitive Level: Knowledge REF: p. 973 OBJ: 4
TOP: Diabetic Ketoacidosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
10. A patient has been admitted to the hospital with the diagnosis of DKA. What vital signs
should a nurse anticipate that the patient will exhibit?
a. Temperature, 99 F; pulse, 62 beats/min; respirations, 16 breaths/min and shallow
b. Temperature, 98.6 F; pulse, 76 beats/min; respirations, 16 breaths/min and deep
c. Temperature, 98 F; pulse, 84 beats/min; respirations, 18 breaths/min and shallow
d. Temperature, 97.4 F; pulse, 110 beats/min; respirations, 26 breaths/min and deep
ANS: D
DKA is caused by the attempt of the body to metabolize fat for energy, which results in an
acidotic state. The classic signs of DKA are hypothermia, tachycardia, and Kussmaul
respirations (rapid and deep) to blow off the acid ions via respirations. The respirations
will have a fruity odor.
DIF: Cognitive Level: Analysis REF: p. 973 OBJ: 4
TOP: Diabetic Ketoacidosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
11. A home health care nurse is assessing a patient with type 1 diabetes who has been
controlled for 6 months. The nurse is surprised and concerned about a blood glucose
reading of 52 mg/dL. What action by this patient most likely caused this episode of
hypoglycemia?
a. Taking a new form of birth control pill this morning
b. Using large amounts of sugar substitute in her tea this morning
c. A 2-hour long exercise class at the spa this morning
d. Administering an insufficient dose of insulin this morning
ANS: C
Excessive exercise used up the glucose that was made available by the insulin taken by the
patient. The patient now has too much insulin for the available glucose and has become
hypoglycemic.
DIF: Cognitive Level: Application REF: p. 977 OBJ: 6
TOP: Diabetes: Treatment KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
12. As part of a teaching plan in preparation for discharge, a patient with type 1 diabetes needs
guidelines for exercise. Which guideline should be included?
a. Plan exercise so that it coincides with the peak action of insulin.
b. Insulin should be injected into the lower extremity before exercise because that site
provides the greatest absorption.
c. Exercise should be performed daily at the same time of day and at the same
intensity.
d. Keep exercise at a minimum to conserve your energy.
ANS: C
If the body is using more glucose than available, the body will draw on fatty acids, which
will give off ketones.
Linton: Medical-Surgical Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse explains that type 1 diabetes mellitus is a disease in which the body does not
produce enough insulin. What is the reason that the blood glucose is elevated?
a. Prolonged elevation of stress hormone (cortisol, epinephrine, glucagon, growth
hormone) levels
b. Malfunction of the glycogen-storing capabilities of the liver
c. Destruction of the beta cells in the pancreas
d. Insulin resistance of the receptor cells in the muscle tissue
ANS: C
Type 1 diabetes mellitus is a disease in which the pancreas does not produce adequate
insulin because of the destruction of beta cells.
DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 2
TOP: Type 1 Diabetes Mellitus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. A patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take
a pill instead of insulin. The nurse explains that in type 2 diabetes mellitus, the body still
makes insulin. What other information is pertinent for the nurse to relay?
a. Overweight and underactive people cannot simply use the insulin produced.
b. Metabolism is slowed in some people, so they have to take a pill to speed up their
metabolism.
c. Sometimes the autoimmune system works against the action of the insulin.
d. The cells become resistant to the action of insulin. Pills are given to increase the
sensitivity.
ANS: D
Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of
insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more
sensitive.
DIF: Cognitive Level: Comprehension REF: pp. 981-982 OBJ: 2
TOP: Type 2 Diabetes Mellitus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
3. A patient tells a nurse that she eats “huge” amounts of food but stays hungry most of the
time. What should the nurse explain as the cause of hunger experienced by persons with
type 1 diabetes?
a. Excess amount of glucose
b. Need for additional calories to correct the increased metabolism
c. Fact that the cells cannot use the blood glucose
d. Need for exercise to stimulate insulin secretion
ANS: C
, The cells cannot use the glucose without insulin, so the patient with diabetes still feels
hungry even though abundant glucose is circulating in the blood.
DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 1
TOP: Hunger in the Patient with Diabetes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. What does the lack of insulin in patients with type 1 diabetes cause that increases the risk
for cardiovascular disorders?
a. High glucose levels that irritate and shrink the vessels
b. Inadequate metabolism of proteins, which causes ketosis
c. Increased fatty acid levels
d. Increased metabolism of ketones, which causes hypertension
ANS: C
The increase in fatty acid levels causes an increase in the level of triglycerides and an
attendant rise in low-density lipoprotein levels.
DIF: Cognitive Level: Knowledge REF: pp. 968-969 OBJ: 1
TOP: Diabetes: Complications KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
5. The self-care goal of a patient with diabetes is to keep the blood sugar within normal
limits. What causes hyperglycemia to occur?
a. Blood glucose levels rise, stimulating the production of insulin.
b. Insulin conversion of glycogen to glucose is inhibited.
c. The body responds to glucose-starved tissues by changing stored glycogen into
glucose.
d. Glycogen is unable to be stored in the liver and muscles.
ANS: C
The hypothalamus is receiving a message that the cells need glucose, so it responds by
adding more glucose to the already overburdened blood.
DIF: Cognitive Level: Comprehension REF: p. 968 OBJ: 1
TOP: Hyperglycemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. A young patient complains that diabetes is causing her to “have no life at all. It’s too
hard.” What is the most helpful response by the nurse?
a. “Yes, you must make some sacrifices.”
b. “It’s hard, but with significant alterations in your lifestyle, you can live a long
life.”
c. “What’s hard about exercise, diet, and medicine?”
d. “Let’s talk about what makes it so hard.”
ANS: D
Involving the patient in decisions about how she will cope with her diabetes will make the
goals more realistic and personal, which will give her a greater chance of success in
meeting them.
, DIF: Cognitive Level: Application REF: p. 990 OBJ: 7
TOP: Diabetes Lifestyle KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
7. When a patient with type 2 diabetes says, “Why in the world are they looking at my
hemoglobin? I thought my problem was with my blood sugar.” What should the nurse
explain about the level of hemoglobin A1c?
a. Shows how a high level of glucose can cause a significant drop in the hemoglobin
level
b. Shows what the glucose level has done during the past 3 months
c. Indicates a true picture of the patient’s nutritional state
d. Reflects the effect of a high level of glucose on the ability to produce red blood
cells (RBCs)
ANS: B
By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose
can be evaluated for the past 3 months because the glucose stays bound to the hemoglobin
for the life of the RBC.
DIF: Cognitive Level: Comprehension REF: p. 983 OBJ: 1
TOP: Hemoglobin A1c: Glycosylated Hemoglobin Level
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. A patient with type 2 diabetes shows a blood sugar reading of 68 at 6 AM. What action
should the nurse implement based on the reading of 72 mg/dL?
a. Notify the charge nurse of the reading.
b. Give regular insulin per a sliding scale.
c. Give him 8 oz of skim milk.
d. Administer the oral glucose tablet.
ANS: C
The patient is hypoglycemic and needs an immediate source of glucose, such as milk or
orange juice. The oral hypoglycemic agent will not work quickly enough. The charge
nurse can be notified later. Giving insulin per a sliding scale would lower the blood sugar
level.
DIF: Cognitive Level: Application REF: p. 991 OBJ: 6
TOP: Hypoglycemic Reaction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. A nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this
is a life-threatening condition. What will DKA result in?
a. Disorder of carbohydrates, fats, and proteins metabolism
b. Storage of glycogen, resulting in a severe shortage of glucose in the bloodstream
c. Dangerously elevated pH and bicarbonate levels in the blood
d. Severe hypoglycemia, which can result in coma and convulsions
ANS: A
DKA is mainly related to the use of fat as an energy source because of an inability of the
body to use glucose. The metabolism of fat produces ketones.
, DIF: Cognitive Level: Knowledge REF: p. 973 OBJ: 4
TOP: Diabetic Ketoacidosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
10. A patient has been admitted to the hospital with the diagnosis of DKA. What vital signs
should a nurse anticipate that the patient will exhibit?
a. Temperature, 99 F; pulse, 62 beats/min; respirations, 16 breaths/min and shallow
b. Temperature, 98.6 F; pulse, 76 beats/min; respirations, 16 breaths/min and deep
c. Temperature, 98 F; pulse, 84 beats/min; respirations, 18 breaths/min and shallow
d. Temperature, 97.4 F; pulse, 110 beats/min; respirations, 26 breaths/min and deep
ANS: D
DKA is caused by the attempt of the body to metabolize fat for energy, which results in an
acidotic state. The classic signs of DKA are hypothermia, tachycardia, and Kussmaul
respirations (rapid and deep) to blow off the acid ions via respirations. The respirations
will have a fruity odor.
DIF: Cognitive Level: Analysis REF: p. 973 OBJ: 4
TOP: Diabetic Ketoacidosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
11. A home health care nurse is assessing a patient with type 1 diabetes who has been
controlled for 6 months. The nurse is surprised and concerned about a blood glucose
reading of 52 mg/dL. What action by this patient most likely caused this episode of
hypoglycemia?
a. Taking a new form of birth control pill this morning
b. Using large amounts of sugar substitute in her tea this morning
c. A 2-hour long exercise class at the spa this morning
d. Administering an insufficient dose of insulin this morning
ANS: C
Excessive exercise used up the glucose that was made available by the insulin taken by the
patient. The patient now has too much insulin for the available glucose and has become
hypoglycemic.
DIF: Cognitive Level: Application REF: p. 977 OBJ: 6
TOP: Diabetes: Treatment KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
12. As part of a teaching plan in preparation for discharge, a patient with type 1 diabetes needs
guidelines for exercise. Which guideline should be included?
a. Plan exercise so that it coincides with the peak action of insulin.
b. Insulin should be injected into the lower extremity before exercise because that site
provides the greatest absorption.
c. Exercise should be performed daily at the same time of day and at the same
intensity.
d. Keep exercise at a minimum to conserve your energy.
ANS: C
If the body is using more glucose than available, the body will draw on fatty acids, which
will give off ketones.
