CHAPTER 48: DIABETES MELLITUS LEWIS:
MEDICAL SURGICAL NURSING, 10TH EDITION
2025/2026.
6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes
who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of
care is most important for this patient?
a. The patient will reach a glycosylated hemoglobin level of less than
7%.
b. The patient will follow a diet and exercise plan that results in weight
loss.
c. The patient will choose a diet that distributes calories throughout the
day.
d. The patient will state the reasons for eliminating simple sugars in the
diet. - correct
answer>>ANS: A
The complications of diabetes are related to elevated blood glucose
and the most important patient outcome is the reduction of glucose to
near-normal levels. A BMI of 30?9?kg/m2 or above is considered obese,
so the other outcomes are appropriate but are not as high in priority.
DIF: Cognitive Level: Analyze (analysis) REF: 1124
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. A patient who has type 1 diabetes plans to swim laps for an hour
daily at 1:00 PM. The clinic nurse will plan to teach the patient to
a. check glucose level before, during, and after swimming.
,b. delay eating the noon meal until after the swimming class.
c. increase the morning dose of neutral protamine Hagedorn (NPH)
insulin.
d. time the morning insulin injection so that the peak occurs while
swimming. - correct answer>>ANS: A
The change in exercise will affect blood glucose, and the patient will
need to monitor glucose carefully to determine the need for changes in
diet and insulin administration. Because exercise tends to decrease
blood glucose, patients are advised to eat before exercising. Increasing
the morning NPH or timing the insulin to peak during exercise may lead
to hypoglycemia, especially with the increased exercise.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning
REF: 1132
MSC: NCLEX: Physiological Integrity
8. The nurse determines a need for additional instruction when the
patient with newly diagnosed type 1 diabetes says which of the
following?
a. "I will need a bedtime snack because I take an evening dose of NPH
insulin."
b. "I can choose any foods, as long as I use enough insulin to cover the
calories."
c. "I can have an occasional beverage with alcohol if I include it in my
meal plan."
,d. "I will eat something at meal times to prevent hypoglycemia, even if I
am not hungry." - correct answer>>ANS: B
Most patients with type 1 diabetes need to plan diet choices very
carefully. Patients who are using intensified insulin therapy have
considerable flexibility in diet choices but still should restrict dietary
intake of items such as fat, protein, and alcohol. The other patient
statements are correct and indicate good understanding of the diet
instruction.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation
REF: 1132
MSC: NCLEX: Physiological Integrity
10. Which statement by the patient indicates a need for additional
instruction in administering insulin?
a. "I need to rotate injection sites among my arms, legs, and abdomen
each day."
b. "I can buy the 0.5-mL syringes because the line markings will be
easier to see."
c. "I do not need to aspirate the plunger to check for blood before
injecting insulin."
d. "I should draw up the regular insulin first, after injecting air into the
NPH bottle." - correct answer>>ANS: A
Rotating sites is no longer recommended because there is more
consistent insulin absorption when the same site is used consistently.
, The other patient statements are accurate and indicate that no
additional instruction is needed.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation
REF: 1128
MSC: NCLEX: Health Promotion and Maintenance
11. Which patient action indicates good understanding of the nurse's
teaching about administration of aspart (NovoLog) insulin?
a. The patient avoids injecting the insulin into the upper abdominal
area.
b. The patient cleans the skin with soap and water before insulin
administration.
c. The patient stores the insulin in the freezer after administering the
prescribed dose.
d. The patient pushes the plunger down while removing the syringe
from the injection site. - correct answer>>ANS: B
Cleaning the skin with soap and water is acceptable. Insulin should not
be frozen. The patient should leave the syringe in place for about 5
seconds after injection to be sure that all the insulin has been injected.
The upper abdominal area is one of the preferred areas for insulin
injection.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation
MEDICAL SURGICAL NURSING, 10TH EDITION
2025/2026.
6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes
who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of
care is most important for this patient?
a. The patient will reach a glycosylated hemoglobin level of less than
7%.
b. The patient will follow a diet and exercise plan that results in weight
loss.
c. The patient will choose a diet that distributes calories throughout the
day.
d. The patient will state the reasons for eliminating simple sugars in the
diet. - correct
answer>>ANS: A
The complications of diabetes are related to elevated blood glucose
and the most important patient outcome is the reduction of glucose to
near-normal levels. A BMI of 30?9?kg/m2 or above is considered obese,
so the other outcomes are appropriate but are not as high in priority.
DIF: Cognitive Level: Analyze (analysis) REF: 1124
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. A patient who has type 1 diabetes plans to swim laps for an hour
daily at 1:00 PM. The clinic nurse will plan to teach the patient to
a. check glucose level before, during, and after swimming.
,b. delay eating the noon meal until after the swimming class.
c. increase the morning dose of neutral protamine Hagedorn (NPH)
insulin.
d. time the morning insulin injection so that the peak occurs while
swimming. - correct answer>>ANS: A
The change in exercise will affect blood glucose, and the patient will
need to monitor glucose carefully to determine the need for changes in
diet and insulin administration. Because exercise tends to decrease
blood glucose, patients are advised to eat before exercising. Increasing
the morning NPH or timing the insulin to peak during exercise may lead
to hypoglycemia, especially with the increased exercise.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning
REF: 1132
MSC: NCLEX: Physiological Integrity
8. The nurse determines a need for additional instruction when the
patient with newly diagnosed type 1 diabetes says which of the
following?
a. "I will need a bedtime snack because I take an evening dose of NPH
insulin."
b. "I can choose any foods, as long as I use enough insulin to cover the
calories."
c. "I can have an occasional beverage with alcohol if I include it in my
meal plan."
,d. "I will eat something at meal times to prevent hypoglycemia, even if I
am not hungry." - correct answer>>ANS: B
Most patients with type 1 diabetes need to plan diet choices very
carefully. Patients who are using intensified insulin therapy have
considerable flexibility in diet choices but still should restrict dietary
intake of items such as fat, protein, and alcohol. The other patient
statements are correct and indicate good understanding of the diet
instruction.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation
REF: 1132
MSC: NCLEX: Physiological Integrity
10. Which statement by the patient indicates a need for additional
instruction in administering insulin?
a. "I need to rotate injection sites among my arms, legs, and abdomen
each day."
b. "I can buy the 0.5-mL syringes because the line markings will be
easier to see."
c. "I do not need to aspirate the plunger to check for blood before
injecting insulin."
d. "I should draw up the regular insulin first, after injecting air into the
NPH bottle." - correct answer>>ANS: A
Rotating sites is no longer recommended because there is more
consistent insulin absorption when the same site is used consistently.
, The other patient statements are accurate and indicate that no
additional instruction is needed.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation
REF: 1128
MSC: NCLEX: Health Promotion and Maintenance
11. Which patient action indicates good understanding of the nurse's
teaching about administration of aspart (NovoLog) insulin?
a. The patient avoids injecting the insulin into the upper abdominal
area.
b. The patient cleans the skin with soap and water before insulin
administration.
c. The patient stores the insulin in the freezer after administering the
prescribed dose.
d. The patient pushes the plunger down while removing the syringe
from the injection site. - correct answer>>ANS: B
Cleaning the skin with soap and water is acceptable. Insulin should not
be frozen. The patient should leave the syringe in place for about 5
seconds after injection to be sure that all the insulin has been injected.
The upper abdominal area is one of the preferred areas for insulin
injection.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Evaluation
