DIABETES MELLITUS NCLEX STYLE QUESTIONS
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which
patient meets the diagnostic criteria for diabetes mellitus?
a. A 48-year-old woman with a hemoglobin A1C of 8.4%
b. A 58-year-old man with a fasting blood glucose of 111 mg/dL
c. A 68-year-old woman with a random plasma glucose of 190 mg/dL
d. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL -
Answers - a. A 48-year-old woman with a hemoglobin A1C of 8.4%
Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting
plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an
oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic
crisis with a random plasma glucose =200 mg/dL.
The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when
drinking alcohol. Intensified insulin therapy, such as the use of an insulin pump, allows
considerable flexibility in food selection and can be adjusted for alterations from usual
eating and exercise habits. However, saturated fat intake should still be limited to less
than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for
the general population and for patients with diabetes mellitus. High-protein diets are not
recommended for weight loss.
Which patient with type 1 diabetes mellitus would be at the highest risk for developing
hypoglycemic unawareness?
a. A 58-year-old patient with diabetic retinopathy
b. A 73-year-old patient who takes propranolol (Inderal)
c. A 19-year-old patient who is on the school track team
d. A 24-year-old patient with a hemoglobin A1C of 8.9% - Answers - b. A 73-year-old
patient who takes propranolol (Inderal)
Hypoglycemic unawareness is a condition in which a person does not experience the
warning signs and symptoms of hypoglycemia until the person becomes incoherent and
combative or loses consciousness. Hypoglycemic awareness is related to autonomic
neuropathy of diabetes that interferes with the secretion of counterregulatory hormones
that produce these symptoms. Older patients and patients who use â-adrenergic
blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent
diabetic nephropathy. Which statement made by the patient indicates that teaching has
been successful?
a. "Smokeless tobacco products decrease the risk of kidney damage."
b. "I can help control my blood pressure by avoiding foods high in salt."
, c. "I should have yearly dilated eye examinations by an ophthalmologist."
d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL." - Answers -
b. "I can help control my blood pressure by avoiding foods high in salt."
Diabetic nephropathy is a microvascular complication associated with damage to the
small blood vessels that supply the glomeruli of the kidney. Risk factors for the
development of diabetic nephropathy include hypertension, genetic predisposition,
smoking, and chronic hyperglycemia. Patients with diabetes are screened for
nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a
serum creatinine is also needed.
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means.
What is the most appropriate response by the nurse?
a. "With type 2 diabetes, the body of the pancreas becomes inflamed."
b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is
increased."
c. "With type 2 diabetes, the patient is totally dependent on an outside source of
insulin."
d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the
pancreas." - Answers - b. "With type 2 diabetes, insulin secretion is decreased, and
insulin resistance is increased."
In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or
the cells of the body become resistant to insulin. The pancreas becomes inflamed with
pancreatitis. The patient is totally dependent on exogenous insulin and may have had
autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.
The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes
mellitus about insulin administration. Which statement by the patient requires an
intervention by the nurse?
a. "I will discard any insulin bottle that is cloudy in appearance."
b. "The best injection site for insulin administration is in my abdomen."
c. "I can wash the site with soap and water before insulin administration."
d. "I may keep my insulin at room temperature (75o F) for up to a month." - Answers - a.
"I will discard any insulin bottle that is cloudy in appearance."
Intermediate-acting insulin and combination premixed insulin will be cloudy in
appearance. Routine hygiene such as washing with soap and rinsing with water is
adequate for skin preparation for the patient during self-injections. Insulin vials that the
patient is currently using may be left at room temperature for up to 4 weeks unless the
room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]).
Rotating sites to different anatomic sites is no longer recommended. Patients should
rotate the injection within one particular site, such as the abdomen.
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which
patient meets the diagnostic criteria for diabetes mellitus?
a. A 48-year-old woman with a hemoglobin A1C of 8.4%
b. A 58-year-old man with a fasting blood glucose of 111 mg/dL
c. A 68-year-old woman with a random plasma glucose of 190 mg/dL
d. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL -
Answers - a. A 48-year-old woman with a hemoglobin A1C of 8.4%
Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting
plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an
oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic
crisis with a random plasma glucose =200 mg/dL.
The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when
drinking alcohol. Intensified insulin therapy, such as the use of an insulin pump, allows
considerable flexibility in food selection and can be adjusted for alterations from usual
eating and exercise habits. However, saturated fat intake should still be limited to less
than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for
the general population and for patients with diabetes mellitus. High-protein diets are not
recommended for weight loss.
Which patient with type 1 diabetes mellitus would be at the highest risk for developing
hypoglycemic unawareness?
a. A 58-year-old patient with diabetic retinopathy
b. A 73-year-old patient who takes propranolol (Inderal)
c. A 19-year-old patient who is on the school track team
d. A 24-year-old patient with a hemoglobin A1C of 8.9% - Answers - b. A 73-year-old
patient who takes propranolol (Inderal)
Hypoglycemic unawareness is a condition in which a person does not experience the
warning signs and symptoms of hypoglycemia until the person becomes incoherent and
combative or loses consciousness. Hypoglycemic awareness is related to autonomic
neuropathy of diabetes that interferes with the secretion of counterregulatory hormones
that produce these symptoms. Older patients and patients who use â-adrenergic
blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent
diabetic nephropathy. Which statement made by the patient indicates that teaching has
been successful?
a. "Smokeless tobacco products decrease the risk of kidney damage."
b. "I can help control my blood pressure by avoiding foods high in salt."
, c. "I should have yearly dilated eye examinations by an ophthalmologist."
d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL." - Answers -
b. "I can help control my blood pressure by avoiding foods high in salt."
Diabetic nephropathy is a microvascular complication associated with damage to the
small blood vessels that supply the glomeruli of the kidney. Risk factors for the
development of diabetic nephropathy include hypertension, genetic predisposition,
smoking, and chronic hyperglycemia. Patients with diabetes are screened for
nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a
serum creatinine is also needed.
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means.
What is the most appropriate response by the nurse?
a. "With type 2 diabetes, the body of the pancreas becomes inflamed."
b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is
increased."
c. "With type 2 diabetes, the patient is totally dependent on an outside source of
insulin."
d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the
pancreas." - Answers - b. "With type 2 diabetes, insulin secretion is decreased, and
insulin resistance is increased."
In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or
the cells of the body become resistant to insulin. The pancreas becomes inflamed with
pancreatitis. The patient is totally dependent on exogenous insulin and may have had
autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.
The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes
mellitus about insulin administration. Which statement by the patient requires an
intervention by the nurse?
a. "I will discard any insulin bottle that is cloudy in appearance."
b. "The best injection site for insulin administration is in my abdomen."
c. "I can wash the site with soap and water before insulin administration."
d. "I may keep my insulin at room temperature (75o F) for up to a month." - Answers - a.
"I will discard any insulin bottle that is cloudy in appearance."
Intermediate-acting insulin and combination premixed insulin will be cloudy in
appearance. Routine hygiene such as washing with soap and rinsing with water is
adequate for skin preparation for the patient during self-injections. Insulin vials that the
patient is currently using may be left at room temperature for up to 4 weeks unless the
room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]).
Rotating sites to different anatomic sites is no longer recommended. Patients should
rotate the injection within one particular site, such as the abdomen.
