NUR 257 Chronic Exam 3 | 45 Actual
Questions and Answers | 2025 Update
| 100% Correct-Galen.
Diabetes Mellitus and Endocrine Disorders
Question 1
An 81-year-old client with type 2 diabetes is admitted with pneumonia. The client
reports feeling "too sick to eat," has vomited twice, 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
Answer: C) Notify the provider about the missed diabetes medication and inability
to tolerate PO intake
Rationale: The client's inability to eat, vomiting, and missed diabetes medications create
significant risk for both hyperglycemia and hypoglycemia. Illness alters glucose needs
and intake, and the provider must be notified to adjust medication orders. As one
source notes, "If you cannot eat, you cannot continue to take your medicine and need to
call your doctor" . While hydration and education are important, notifying the provider is
the priority action to prevent complications .
,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."
Answer: 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."
Rationale: This response reflects the "15/15 rule" for hypoglycemia management—
consume 15 grams of fast-acting carbohydrate and recheck blood glucose in 15
minutes . Fat-free milk contains carbohydrates for rapid glucose elevation. The other
options represent dangerous misconceptions: hypoglycemia does not "pass" on its own,
taking diabetes pills during hypoglycemia is inappropriate, and hypoglycemia must be
treated regardless of appetite.
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
Answer: B) Average blood glucose has been around 154 mg/dL, which reflects
moderate control but still some hyperglycemia
Rationale: An A1C of 7% corresponds to an estimated average glucose of
approximately 154 mg/dL over the previous 3 months . While this may be an acceptable
target for many older adults depending on comorbidities and functional status, it still
indicates some hyperglycemia and requires ongoing evaluation and teaching . An A1C
of 6% would correspond to ~126 mg/dL, and A1C reflects 3 months, not 24 hours.
Question 4
A client with type 2 diabetes is being educated on footwear. What is the most important
point the nurse should emphasize regarding shoe fit?
A) "Choose shoes with open toes to improve air flow."
B) "Make sure new shoes fit well, not too tight, not too loose, and show even wear
patterns."
C) "Buy shoes a size larger to avoid pressure."
D) "Break in new shoes by wearing them all day immediately."
Answer: B) "Make sure new shoes fit well, not too tight, not too loose, and show
even wear patterns."
Rationale: Properly fitting shoes prevent pressure points, blisters, and ulcers in
neuropathic feet . Older adults with sensory loss may not feel early injury, so proper fit
, and inspection of wear patterns are crucial for preventing serious complications. Open-
toed shoes, oversized shoes, and wearing new shoes all day without breaking them in all
increase injury risk.
Question 5
A 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."
Answer: B) "High levels of sugar in your urine can irritate the bladder, and nerve
damage from diabetes can also affect bladder control."
Rationale: Excess glucose in the urine causes osmotic diuresis, polyuria, and potential
urgency or incontinence . Long-standing hyperglycemia also contributes to autonomic
neuropathy affecting bladder control. This explanation addresses both acute and
chronic mechanisms while avoiding inappropriate alarmism .
Question 6
The nurse is caring for a client with type 2 diabetes. Which instruction is key to
preventing microvascular and macrovascular problems?
Questions and Answers | 2025 Update
| 100% Correct-Galen.
Diabetes Mellitus and Endocrine Disorders
Question 1
An 81-year-old client with type 2 diabetes is admitted with pneumonia. The client
reports feeling "too sick to eat," has vomited twice, 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
Answer: C) Notify the provider about the missed diabetes medication and inability
to tolerate PO intake
Rationale: The client's inability to eat, vomiting, and missed diabetes medications create
significant risk for both hyperglycemia and hypoglycemia. Illness alters glucose needs
and intake, and the provider must be notified to adjust medication orders. As one
source notes, "If you cannot eat, you cannot continue to take your medicine and need to
call your doctor" . While hydration and education are important, notifying the provider is
the priority action to prevent complications .
,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."
Answer: 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."
Rationale: This response reflects the "15/15 rule" for hypoglycemia management—
consume 15 grams of fast-acting carbohydrate and recheck blood glucose in 15
minutes . Fat-free milk contains carbohydrates for rapid glucose elevation. The other
options represent dangerous misconceptions: hypoglycemia does not "pass" on its own,
taking diabetes pills during hypoglycemia is inappropriate, and hypoglycemia must be
treated regardless of appetite.
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
Answer: B) Average blood glucose has been around 154 mg/dL, which reflects
moderate control but still some hyperglycemia
Rationale: An A1C of 7% corresponds to an estimated average glucose of
approximately 154 mg/dL over the previous 3 months . While this may be an acceptable
target for many older adults depending on comorbidities and functional status, it still
indicates some hyperglycemia and requires ongoing evaluation and teaching . An A1C
of 6% would correspond to ~126 mg/dL, and A1C reflects 3 months, not 24 hours.
Question 4
A client with type 2 diabetes is being educated on footwear. What is the most important
point the nurse should emphasize regarding shoe fit?
A) "Choose shoes with open toes to improve air flow."
B) "Make sure new shoes fit well, not too tight, not too loose, and show even wear
patterns."
C) "Buy shoes a size larger to avoid pressure."
D) "Break in new shoes by wearing them all day immediately."
Answer: B) "Make sure new shoes fit well, not too tight, not too loose, and show
even wear patterns."
Rationale: Properly fitting shoes prevent pressure points, blisters, and ulcers in
neuropathic feet . Older adults with sensory loss may not feel early injury, so proper fit
, and inspection of wear patterns are crucial for preventing serious complications. Open-
toed shoes, oversized shoes, and wearing new shoes all day without breaking them in all
increase injury risk.
Question 5
A 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."
Answer: B) "High levels of sugar in your urine can irritate the bladder, and nerve
damage from diabetes can also affect bladder control."
Rationale: Excess glucose in the urine causes osmotic diuresis, polyuria, and potential
urgency or incontinence . Long-standing hyperglycemia also contributes to autonomic
neuropathy affecting bladder control. This explanation addresses both acute and
chronic mechanisms while avoiding inappropriate alarmism .
Question 6
The nurse is caring for a client with type 2 diabetes. Which instruction is key to
preventing microvascular and macrovascular problems?
