Exam 3: NUR 257/ NUR257 Diabetes and Geriatric Care |
Actual Questions and Answers Latest Updated (Graded A+)-
Galen
Question 1
An 81-year-old client with type 2 diabetes is admitted with pneumonia. The client reports feeling “too sick
to eat,” has had vomiting twice this morning, and says, “I didn’t take my diabetes pills today because I
figured I didn’t need them.” Which nursing action is the priority?
A. Encourage the client to take small sips of clear liquids as tolerated
B. Reinforce the importance of daily foot inspections while hospitalized
C. Notify the provider about the missed diabetes medication and inability to tolerate PO intake
D. Educate the client on the importance of annual influenza and pneumonia vaccines
Question 2
The nurse is reinforcing teaching about hypoglycemia management with an older adult who lives alone
and has type 2 diabetes. Which client statement indicates correct understanding?
A. “If I feel shaky and sweaty, I’ll drink a cup of fat-free milk and check my sugar again in about 15
minutes.”
B. “If I get confused or dizzy, I’ll just lay down and rest. It usually passes by itself.”
C. “If my blood sugar is low, I’ll take my diabetes pill with orange juice so it works faster.”
D. “If I’m not hungry, I should avoid treating low blood sugar so I don’t gain weight.”
Question 3
A nurse reviews laboratory results for a 77-year-old client with diabetes. The hemoglobin A1C is 7%.
Which interpretation is most accurate?
A. Average blood glucose has been around 126 mg/dL over the past 3 months, indicating excellent
control
B. Average blood glucose has been around 154 mg/dL, which reflects moderate control but still some
hyperglycemia
C. The result only reflects blood glucose over the last 24 hours and is therefore not clinically useful
D. The result is expected in older adults and requires no further evaluation or teaching
Question 4
An older adult with long-standing type 2 diabetes reports “pins and needles” in both feet and difficulty
feeling the floor when walking. Which interventions should the nurse prioritize to reduce future
complications? Select all that apply.
A. Encourage the client to walk barefoot indoors to increase sensory stimulation
B. Instruct the client to inspect feet daily using a mirror for areas they cannot see
C. Recommend well-fitting shoes and avoidance of tight socks or shoes
,D. Advise the client to soak feet in hot water daily to improve circulation
E. Reinforce the need to notify the provider about any non-healing foot wounds
Question 5
An 84-year-old client with diabetes is newly experiencing urinary incontinence. The client says, “I never
had bladder problems before. Why is this happening now?” Which explanation by the nurse is most
appropriate?
A. “This is just a normal part of aging and unrelated to your diabetes.”
B. “High levels of sugar in your urine can irritate the bladder, and nerve damage from diabetes can also
affect bladder control.”
C. “Your incontinence is caused only by weak pelvic floor muscles and has nothing to do with your blood
sugar.”
D. “It means your kidneys are shutting down and dialysis may soon be necessary.”
Question 6
The nurse is planning care for an older adult with Parkinson’s disease. Which intervention is most
appropriate for scheduling outpatient appointments and therapies?
A. Schedule appointments early in the morning before the first dose of levodopa/carbidopa
B. Schedule appointments late morning or early afternoon when medications are at peak effectiveness
C. Alternate morning and evening appointments to prevent routine dependence
D. Schedule appointments at bedtime when the client is less active and more relaxed
Question 7
The nurse observes an older adult with Parkinson’s disease attempting to drink hot coffee. The client has
visible resting tremors and mild rigidity. Which nursing action is most appropriate?
A. Encourage independence and allow the client to drink the hot coffee unassisted
B. Replace the hot coffee with ice water to avoid burns
C. Offer the hot beverage in a cup with a lid and provide standby assistance
D. Restrict all oral fluids until tremors subside
Question 8
An older adult client is admitted after a right-hemispheric stroke. Which nursing interventions should be
included in the plan of care? Select all that apply.
A. Place frequently used items directly in front of the client
B. Encourage the client to scan the environment while ambulating
C. Emphasize washing and caring for the unaffected side first
D. Label the client as a fall risk due to visual-spatial deficits
E. Expect primarily expressive language deficits with preserved comprehension
,Question 9
The nurse is caring for a client with suspected Wernicke’s aphasia following a stroke. Which assessment
finding is most consistent with this diagnosis?
A. The client speaks easily and rapidly, but the words are nonsensical and the client has poor
understanding of what is said
B. The client understands speech but responds with slow, effortful speech using very few words
C. The client is unable to understand spoken language and cannot produce meaningful speech
D. The client speaks and understands fairly well but frequently pauses, unable to find specific words
Question 10
A 79-year-old client with newly diagnosed Alzheimer’s disease is being discharged home with family.
Which action by the nurse best promotes autonomy and person-centered care?
A. Delay discussion of advance directives until the disease progresses so the client is not overwhelmed
B. Focus education solely on safety and avoid involving the client in decisions about future care
C. Discuss advance directives and treatment preferences with the client now while they can still
participate meaningfully
D. Explain to the family that only they should decide on treatment preferences because the client will
become confused
ANSWER KEY & RATIONALES (Questions 1–10)
Q1: Correct answer – C
● C. Notify the provider… – Priority is that the client cannot keep food/fluids down and skipped
diabetes meds while acutely ill. This directly violates sick-day rules (continue meds and contact
provider if unable to keep food/fluids down). This requires immediate provider notification to
adjust the regimen and prevent DKA/HHS.
● A – Encouraging fluids is good, but not priority over notifying provider about missed meds and
inability to tolerate PO.
● B – Important for diabetes, but not acute priority in this scenario.
● D – Preventive teaching, but not the urgent issue right now.
Q2: Correct answer – A
● A. Cup of fat-free milk + recheck in ~15 min – Correct. Milk contains ~15 g fast-acting carbs
(lactose) and is appropriate for treating mild hypoglycemia in an older adult able to swallow.
, Checking again in 15 minutes reflects the “15/15 rule.”
● B – Dangerous; hypoglycemia does not just “pass” and can worsen.
● C – Taking diabetes pills during hypoglycemia is inappropriate and may worsen the low BG.
● D – Hypoglycemia must be treated regardless of appetite; weight control is not the priority.
Q3: Correct answer – B
● B. ~154 mg/dL; moderate control – Instructor specifically linked A1C 7% ≈ 154 mg/dL
average over 90 days. This indicates some hyperglycemia but is often a common target in older
adults, depending on comorbidities.
● A – 126 mg/dL corresponds more closely with A1C 6%, not 7%.
● C – A1C reflects ~3 months, not 24 hours.
● D – It’s not something to ignore; still requires evaluation and education.
Q4: Correct answers – B, C, E
● B. Daily inspection using a mirror – Correct. Daily foot exams are a priority self-management
skill; mirrors help older adults see the soles of their feet.
● C. Well-fitting shoes – Correct. Prevents skin breakdown and injury in clients with neuropathy.
● E. Notify provider about non-healing wounds – Correct. Essential to prevent infection and
amputation.
● A – Walking barefoot is contraindicated due to risk of injury and poor sensation.
● D – Hot water increases risk of burns, especially with neuropathy.
Q5: Correct answer – B
● B. Glycosuria + neuropathy explanation – Correct. High glucose in urine can irritate the
bladder wall, and long-term hyperglycemia can cause nerve damage that impairs bladder
function, leading to incontinence.
● A – Dismissive and incorrect; it is related to diabetes.
● C – Oversimplifies and ignores the contribution of glycosuria and neuropathy.
Actual Questions and Answers Latest Updated (Graded A+)-
Galen
Question 1
An 81-year-old client with type 2 diabetes is admitted with pneumonia. The client reports feeling “too sick
to eat,” has had vomiting twice this morning, and says, “I didn’t take my diabetes pills today because I
figured I didn’t need them.” Which nursing action is the priority?
A. Encourage the client to take small sips of clear liquids as tolerated
B. Reinforce the importance of daily foot inspections while hospitalized
C. Notify the provider about the missed diabetes medication and inability to tolerate PO intake
D. Educate the client on the importance of annual influenza and pneumonia vaccines
Question 2
The nurse is reinforcing teaching about hypoglycemia management with an older adult who lives alone
and has type 2 diabetes. Which client statement indicates correct understanding?
A. “If I feel shaky and sweaty, I’ll drink a cup of fat-free milk and check my sugar again in about 15
minutes.”
B. “If I get confused or dizzy, I’ll just lay down and rest. It usually passes by itself.”
C. “If my blood sugar is low, I’ll take my diabetes pill with orange juice so it works faster.”
D. “If I’m not hungry, I should avoid treating low blood sugar so I don’t gain weight.”
Question 3
A nurse reviews laboratory results for a 77-year-old client with diabetes. The hemoglobin A1C is 7%.
Which interpretation is most accurate?
A. Average blood glucose has been around 126 mg/dL over the past 3 months, indicating excellent
control
B. Average blood glucose has been around 154 mg/dL, which reflects moderate control but still some
hyperglycemia
C. The result only reflects blood glucose over the last 24 hours and is therefore not clinically useful
D. The result is expected in older adults and requires no further evaluation or teaching
Question 4
An older adult with long-standing type 2 diabetes reports “pins and needles” in both feet and difficulty
feeling the floor when walking. Which interventions should the nurse prioritize to reduce future
complications? Select all that apply.
A. Encourage the client to walk barefoot indoors to increase sensory stimulation
B. Instruct the client to inspect feet daily using a mirror for areas they cannot see
C. Recommend well-fitting shoes and avoidance of tight socks or shoes
,D. Advise the client to soak feet in hot water daily to improve circulation
E. Reinforce the need to notify the provider about any non-healing foot wounds
Question 5
An 84-year-old client with diabetes is newly experiencing urinary incontinence. The client says, “I never
had bladder problems before. Why is this happening now?” Which explanation by the nurse is most
appropriate?
A. “This is just a normal part of aging and unrelated to your diabetes.”
B. “High levels of sugar in your urine can irritate the bladder, and nerve damage from diabetes can also
affect bladder control.”
C. “Your incontinence is caused only by weak pelvic floor muscles and has nothing to do with your blood
sugar.”
D. “It means your kidneys are shutting down and dialysis may soon be necessary.”
Question 6
The nurse is planning care for an older adult with Parkinson’s disease. Which intervention is most
appropriate for scheduling outpatient appointments and therapies?
A. Schedule appointments early in the morning before the first dose of levodopa/carbidopa
B. Schedule appointments late morning or early afternoon when medications are at peak effectiveness
C. Alternate morning and evening appointments to prevent routine dependence
D. Schedule appointments at bedtime when the client is less active and more relaxed
Question 7
The nurse observes an older adult with Parkinson’s disease attempting to drink hot coffee. The client has
visible resting tremors and mild rigidity. Which nursing action is most appropriate?
A. Encourage independence and allow the client to drink the hot coffee unassisted
B. Replace the hot coffee with ice water to avoid burns
C. Offer the hot beverage in a cup with a lid and provide standby assistance
D. Restrict all oral fluids until tremors subside
Question 8
An older adult client is admitted after a right-hemispheric stroke. Which nursing interventions should be
included in the plan of care? Select all that apply.
A. Place frequently used items directly in front of the client
B. Encourage the client to scan the environment while ambulating
C. Emphasize washing and caring for the unaffected side first
D. Label the client as a fall risk due to visual-spatial deficits
E. Expect primarily expressive language deficits with preserved comprehension
,Question 9
The nurse is caring for a client with suspected Wernicke’s aphasia following a stroke. Which assessment
finding is most consistent with this diagnosis?
A. The client speaks easily and rapidly, but the words are nonsensical and the client has poor
understanding of what is said
B. The client understands speech but responds with slow, effortful speech using very few words
C. The client is unable to understand spoken language and cannot produce meaningful speech
D. The client speaks and understands fairly well but frequently pauses, unable to find specific words
Question 10
A 79-year-old client with newly diagnosed Alzheimer’s disease is being discharged home with family.
Which action by the nurse best promotes autonomy and person-centered care?
A. Delay discussion of advance directives until the disease progresses so the client is not overwhelmed
B. Focus education solely on safety and avoid involving the client in decisions about future care
C. Discuss advance directives and treatment preferences with the client now while they can still
participate meaningfully
D. Explain to the family that only they should decide on treatment preferences because the client will
become confused
ANSWER KEY & RATIONALES (Questions 1–10)
Q1: Correct answer – C
● C. Notify the provider… – Priority is that the client cannot keep food/fluids down and skipped
diabetes meds while acutely ill. This directly violates sick-day rules (continue meds and contact
provider if unable to keep food/fluids down). This requires immediate provider notification to
adjust the regimen and prevent DKA/HHS.
● A – Encouraging fluids is good, but not priority over notifying provider about missed meds and
inability to tolerate PO.
● B – Important for diabetes, but not acute priority in this scenario.
● D – Preventive teaching, but not the urgent issue right now.
Q2: Correct answer – A
● A. Cup of fat-free milk + recheck in ~15 min – Correct. Milk contains ~15 g fast-acting carbs
(lactose) and is appropriate for treating mild hypoglycemia in an older adult able to swallow.
, Checking again in 15 minutes reflects the “15/15 rule.”
● B – Dangerous; hypoglycemia does not just “pass” and can worsen.
● C – Taking diabetes pills during hypoglycemia is inappropriate and may worsen the low BG.
● D – Hypoglycemia must be treated regardless of appetite; weight control is not the priority.
Q3: Correct answer – B
● B. ~154 mg/dL; moderate control – Instructor specifically linked A1C 7% ≈ 154 mg/dL
average over 90 days. This indicates some hyperglycemia but is often a common target in older
adults, depending on comorbidities.
● A – 126 mg/dL corresponds more closely with A1C 6%, not 7%.
● C – A1C reflects ~3 months, not 24 hours.
● D – It’s not something to ignore; still requires evaluation and education.
Q4: Correct answers – B, C, E
● B. Daily inspection using a mirror – Correct. Daily foot exams are a priority self-management
skill; mirrors help older adults see the soles of their feet.
● C. Well-fitting shoes – Correct. Prevents skin breakdown and injury in clients with neuropathy.
● E. Notify provider about non-healing wounds – Correct. Essential to prevent infection and
amputation.
● A – Walking barefoot is contraindicated due to risk of injury and poor sensation.
● D – Hot water increases risk of burns, especially with neuropathy.
Q5: Correct answer – B
● B. Glycosuria + neuropathy explanation – Correct. High glucose in urine can irritate the
bladder wall, and long-term hyperglycemia can cause nerve damage that impairs bladder
function, leading to incontinence.
● A – Dismissive and incorrect; it is related to diabetes.
● C – Oversimplifies and ignores the contribution of glycosuria and neuropathy.
