TEST BANK FOR DIABETES MELLITUS NCLEX

TEST BANK FOR DIABETES MELLITUS NCLEX PART A 1. Question Knowing that gluconeogenesis helps to maintain blood glucose levels, a nurse should: A. Document weight changes because of fatty acid mobilization. B. Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation. C. Protect the patient from sources of infection because of decreased cellular protein deposits. D. Do all of the above. Correct answer: D. Do all of the above All measures ensure gluconeogenesis in maintaining glucose homeostasis. The purpose of gluconeogenesis is to maintain blood glucose levels during a fast. In the human body, some tissues rely almost exclusively on glucose as a metabolic fuel source. 2. Question The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment, except: A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth Correct answer: A. Hypoglycemia Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM. 3. Question Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. 5.6% Correct Answer: B. 5.7-6.4% Glycosylated hemoglobin levels between 5.7%-6.4% are considered as pre-diabetes. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person’s level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. Anyone with an HbA1c value of 5.7 % to 6.4 % is considered to be prediabetic 4. Question Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every: A. Third day B. Every other day C. 1-2 weeks D. 2-4 weeks Correct Answer: C. 1-2 weeks Rotation of sites for insulin injection should be done every week or two. Frequently using the same spot over time can cause fat cells to break down or build up (lipodystrophy) causing lumps under the skin and may interfere with insulin absorption. 5. Question A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A. Blurred vision B. Diaphoresis C. Nausea D. Weakness Correct Answer: B. Diaphoresis A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the release of epinephrine and norepinephrine resulting in diaphoresis. Low blood sugars can affect activity in the autonomic nervous system (ANS), which is responsible for reactions that people cannot control, such as sweating and digestion. The cholinergic system is a part of the ANS, and it regulates the production of sweat and other secretions. Activation of this system can lead to sweating. 6. Question Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following, except: A. Integumentary inspection for the presence of brown spots on the lower extremities B. Observation for paleness of the lower extremities C. Observation for blanching of the feet after the legs are elevated for 60 seconds D. Palpation for increased pulse volume in the arteries of the lower extremities Correct Answer: D. Palpation for increased pulse volume in the arteries of the lower extremities One of the signs and symptoms of impaired peripheral arterial circulation is the absence of a pulse or a weak pulse in the legs or feet. A general concept to bear in mind is that anything impinging the vessel can decrease peripheral pulses. 7. Question The nurse expects that a type 1 diabetic may receive how much of his or her morning dose of insulin preoperatively? A. 10-20% B. 25-40% C. 50-60% D. 85-90% Correct Answer: C. 50-60% Surgical procedures may result in a number of metabolic perturbations that can alter normal glucose homeostasis. Patients with type 1 diabetes mellitus who are using long-acting insulins, such as glargine, should continue these as normal when fasting. Patients taking premixed insulins or fixed-combination insulins are more of a challenge. It may not be feasible or economical to change the patient’s premixed insulin just before surgery. In these situations, the patient can take ½ – ¾ of the morning dose, followed by administration of a dextrose-containing intravenous fluid and frequent blood glucose checks. 8. Question Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330 Correct Answer: B. 1330 and 1930 The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours. 9. Question A male nurse is providing a bedtime snack for his patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of: A. 6-8 hours B. 10-14 hours C. 14-18 hours D. 24-28 hours Correct Answer: C. 14-18 hours Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four hours, a peak of 4 to 12 hours, and a duration of 14 to 18 hours. They are absorbed more slowly, and last longer. They are also used to control the blood sugar overnight while fasting and between meals. 10. Question A nurse went to a patient’s room to do routine vital signs monitoring and found out that the patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for: A. Elevated serum bicarbonate and decreased blood pH B. Signs of hypoglycemia earlier than expected C. Symptoms of hyperglycemia during the peak time of NPH insulin D. Sugar in the urine Correct answer: B. Signs of hypoglycemia earlier than expected. Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes.