New Book

Lewis 9th

1. Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is correct?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when the patient is admitted with a
hyperglycemic coma.

ANS: C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose
control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1
diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient
develops complications such as frequent yeast infections.
DIF: Cognitive Level: Understand (comprehension) REF: 1166-1167
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose
level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about
a. self-monitoring of blood glucose.
b. using low doses of regular insulin.
c. lifestyle changes to lower blood glucose.
d. effects of oral hypoglycemic medications.

ANS: C
The patient’s impaired fasting glucose indicates prediabetes, and the patient should be counseled about
lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not
require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
DIF: Cognitive Level: Apply (application) REF: 1156
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 28-year-old male patient with type 1 diabetes reports how he manages his exercise
and glucose control. Which behavior indicates that the nurse should implement additional
teaching?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine.

ANS: D
When the patient is ketotic, exercise may result in an increase in blood glucose level. Type 1 diabetic
patients should be taught to avoid exercise when ketosis is present. The other statements are correct.
DIF: Cognitive Level: Apply (application) REF: 1167
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

The nurse is assessing a 22-year-old patient experiencing the onset of symptoms of type
1 diabetes. Which question is most appropriate for the nurse to ask?
a. “Are you anorexic?”
b. “Is your urine dark colored?”
c. “Have you lost weight lately?”
d. “Do you crave sugary drinks?”

ANS: C
Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein
and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased
appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very
dilute.
DIF: Cognitive Level: Apply (application) REF: 1156
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several
months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for
the patient?
a. Urine dipstick for glucose
b. Oral glucose tolerance test
c. Fasting blood glucose level
d. Glycosylated hemoglobin level

ANS: D
The glycosylated hemoglobin (A1C or HbA1C) test shows the overall control of glucose over 90 to 120
days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an
accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral
glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once
diabetes has been diagnosed.
DIF: Cognitive Level: Apply (application) REF: 1157
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 55-year-old female patient with type 2 diabetes has a nursing diagnosis of imbalanced
nutrition: more than body requirements. Which goal 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.

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. The other outcomes also are appropriate but
are not as high in priority.
DIF: Cognitive Level: Apply (application) REF: 1157
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

A 38-year-old patient who has type 1 diabetes plans to swim laps 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.

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) REF: 1168
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

The nurse determines a need for additional instruction when the patient with newly
diagnosed type 1 diabetes says which of the following?
a. “I can have an occasional alcoholic drink if I include it in my meal plan.”
b. “I will need a bedtime snack because I take an evening dose of NPH insulin.”
c. “I can choose any foods, as long as I use enough insulin to cover the calories.”
d. “I will eat something at meal times to prevent hypoglycemia, even if I am not
hungry.”

ANS: C
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) REF: 1165-1166
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

In order to assist an older diabetic patient to engage in moderate daily exercise, which
action is most important for the nurse to take?
a. Determine what type of activities the patient enjoys.
b. Remind the patient that exercise will improve self-esteem.
c. Teach the patient about the effects of exercise on glucose level.
d. Give the patient a list of activities that are moderate in intensity.

ANS: A
Because consistency with exercise is important, assessment for the types of exercise that the patient finds
enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The
other actions will also be implemented but are not the most important in improving compliance.
DIF: Cognitive Level: Apply (application) REF: 1186
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

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 should draw up the regular insulin first after injecting air into the NPH bottle.”
d. “I do not need to aspirate the plunger to check for blood before injecting insulin.”

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) REF: 1160-1161
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

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.

ANS: B
Cleaning the skin with soap and water or with alcohol 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) REF: 1161
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most
important for the nurse to monitor for symptoms of hypoglycemia?
a. 10:00 AM
b. 12:00 AM
c. 2:00 PM
d. 4:00 PM

ANS: A
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the
other listed times, although hypoglycemia may occur.
DIF: Cognitive Level: Understand (comprehension) REF: 1159
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

Which patient action indicates a good understanding of the nurse’s teaching about the
use of an insulin pump?
a. The patient programs the pump for an insulin bolus after eating.
b. The patient changes the location of the insertion site every week.
c. The patient takes the pump off at bedtime and starts it again each morning.
d. The patient plans for a diet that is less flexible when using the insulin pump.

ANS: A
In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after
each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or
3 days. There is more flexibility in diet and exercise when an insulin pump is used. The pump will deliver
a basal insulin rate 24 hours a day.
DIF: Cognitive Level: Apply (application) REF: 1162
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

A 32-year-old patient with diabetes is starting on intensive insulin therapy. Which type
of insulin will the nurse discuss using for mealtime coverage?
a. Lispro (Humalog)
b. Glargine (Lantus)
c. Detemir (Levemir)
d. NPH (Humulin N)

ANS: A
Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin
therapy. NPH, glargine, or detemir will be used as the basal insulin.
DIF: Cognitive Level: Apply (application) REF: 1158
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Which information will the nurse include when teaching a 50-year-old patient who has
type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)?
a. Glyburide decreases glucagon secretion from the pancreas.
b. Glyburide stimulates insulin production and release from the pancreas.
c. Glyburide should be taken even if the morning blood glucose level is low.
d. Glyburide should not be used for 48 hours after receiving IV contrast media.

ANS: B
The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is
low, the patient should contact the health care provider before taking the glyburide, because
hypoglycemia can occur with this class of medication. Metformin should be held for 48 hours after
administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not
affected by glyburide.
DIF: Cognitive Level: Apply (application) REF: 1163
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse has been teaching a patient with type 2 diabetes about managing blood
glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for
additional teaching?
a. “If I overeat at a meal, I will still take the usual dose of medication.”
b. “Other medications besides the Glucotrol may affect my blood sugar.”
c. “When I am ill, I may have to take insulin to control my blood sugar.”
d. “My diabetes won’t cause complications because I don’t need insulin.”

ANS: D
The patient should understand that type 2 diabetes places the patient at risk for many complications and
that good glucose control is as important when taking oral agents as when using insulin. The other
statements are accurate and indicate good understanding of the use of glipizide.
DIF: Cognitive Level: Apply (application) REF: 1158
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops
an allergic rash from an unknown cause, the health care provider prescribes prednisone
(Deltasone). The nurse will anticipate that the patient may
a. need a diet higher in calories while receiving prednisone.
b. develop acute hypoglycemia while taking the prednisone.
c. require administration of insulin while taking prednisone.
d. have rashes caused by metformin-prednisone interactions.

ANS: C
Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control
blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused
by taking metformin and prednisone simultaneously. The patient may have an increased appetite when
taking prednisone, but will not need a diet that is higher in calories.
DIF: Cognitive Level: Apply (application) REF: 1175
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A hospitalized diabetic patient received 38 U of NPH insulin at 7:00 AM. At 1:00 PM,
the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while
awaiting a chest x-ray. To prevent hypoglycemia, the best action by the nurse is to
a. save the lunch tray for the patient’s later return to the unit.
b. ask that diagnostic testing area staff to start a 5% dextrose IV.
c. send a glass of milk or orange juice to the patient in the diagnostic testing area.
d. request that if testing is further delayed, the patient be returned to the unit to eat.

ANS: D
Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to
have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia.
Administration of an IV solution is unnecessarily invasive for the patient. A glass of milk or juice will
keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the
rapid absorption of the simple carbohydrate in these items.
DIF: Cognitive Level: Apply (application) REF: 1166
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse identifies a need for additional teaching when the patient who is selfmonitoring
blood glucose
a. washes the puncture site using warm water and soap.
b. chooses a puncture site in the center of the finger pad.
c. hangs the arm down for a minute before puncturing the site.
d. says the result of 120 mg indicates good blood sugar control.

ANS: B
The patient is taught to choose a puncture site at the side of the finger pad because there are fewer nerve
endings along the side of the finger pad. The other patient actions indicate that teaching has been
effective.
DIF: Cognitive Level: Apply (application) REF: 1169
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2
diabetes about home management of the disease. Which action should the nurse take first?
a. Ask the patient’s family to participate in the diabetes education program.
b. Assess the patient’s perception of what it means to have diabetes mellitus.
c. Demonstrate how to check glucose using capillary blood glucose monitoring.
d. Discuss the need for the patient to actively participate in diabetes management.

ANS: B
Before planning teaching, the nurse should assess the patient’s interest in and ability to self-manage the
diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to
be individualized to each patient.
DIF: Cognitive Level: Apply (application) REF: 1172
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

An unresponsive patient with type 2 diabetes is brought to the emergency department
and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the
need to
a. give a bolus of 50% dextrose.
b. insert a large-bore IV catheter.
c. initiate oxygen by nasal cannula.
d. administer glargine (Lantus) insulin.

ANS: B
HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is
administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose
solutions will increase the patient’s blood glucose and would be contraindicated.
DIF: Cognitive Level: Apply (application) REF: 1178
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after
caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood
glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog)
insulin. The nurse advises the patient to
a. use only the lispro insulin until the symptoms are resolved.
b. limit intake of calories until the glucose is less than 120 mg/dL.
c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.

ANS: C
Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose
frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose
levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead
to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the
patient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate shortterm
alterations in blood glucose.
DIF: Cognitive Level: Apply (application) REF: 1171-1172
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The health care provider suspects the Somogyi effect in a 50-year-old patient whose
6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
a. Avoid snacking at bedtime.
b. Increase the rapid-acting insulin dose.
c. Check the blood glucose during the night
d. Administer a larger dose of long-acting insulin.

ANS: C
If the Somogyi effect is causing the patient’s increased morning glucose level, the patient will experience
hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced, rather than increased. A
bedtime snack is used to prevent hypoglycemic episodes during the night.
DIF: Cognitive Level: Apply (application) REF: 1163
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Which action should the nurse take after a 36-year-old patient treated with
intramuscular glucagon for hypoglycemia regains consciousness?
a. Assess the patient for symptoms of hyperglycemia.
b. Give the patient a snack of peanut butter and crackers.
c. Have the patient drink a glass of orange juice or nonfat milk.
d. Administer a continuous infusion of 5% dextrose for 24 hours.

ANS: B
Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex
carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will
elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of
IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be
assessed for symptoms of hypoglycemia after glucagon administration.
DIF: Cognitive Level: Apply (application) REF: 1179
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which question during the assessment of a diabetic patient will help the nurse identify
autonomic neuropathy?
a. “Do you feel bloated after eating?”
b. “Have you seen any skin changes?”
c. “Do you need to increase your insulin dosage when you are stressed?”
d. “Have you noticed any painful new ulcerations or sores on your feet?”

ANS: A
Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the
patient. The other questions are also appropriate to ask but would not help in identifying autonomic
neuropathy.
DIF: Cognitive Level: Apply (application) REF: 1183
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which information will the nurse include in teaching a female patient who has
peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs?
a. Choose flat-soled leather shoes.
b. Set heating pads on a low temperature.
c. Use callus remover for corns or calluses.
d. Soak feet in warm water for an hour each day.

ANS: A
The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed,
but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn
removers should be avoided. The patient should see a specialist to treat these problems.
DIF: Cognitive Level: Apply (application) REF: 1184
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which finding indicates a need to contact the health care provider before the nurse
administers metformin (Glucophage)?
a. The patient’s blood glucose level is 174 mg/dL.
b. The patient has gained 2 lb (0.9 kg) since yesterday.
c. The patient is scheduled for a chest x-ray in an hour.
d. The patient’s blood urea nitrogen (BUN) level is 52 mg/dL.

ANS: D
The BUN indicates possible renal failure, and metformin should not be used in patients with renal failure.
The other findings are not contraindications to the use of metformin.
DIF: Cognitive Level: Apply (application) REF: 1163
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A diabetic patient who has reported burning foot pain at night receives a new
prescription. Which information should the nurse teach the patient about amitriptyline (Elavil)?
a. Amitriptyline decreases the depression caused by your foot pain.
b. Amitriptyline helps prevent transmission of pain impulses to the brain.
c. Amitriptyline corrects some of the blood vessel changes that cause pain.
d. Amitriptyline improves sleep and makes you less aware of nighttime pain.

ANS: B
Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain.
Tricyclic antidepressants also improve sleep quality and are used for depression, but that is not the major
purpose for their use in diabetic neuropathy. The blood vessel changes that contribute to neuropathy are
not affected by tricyclic antidepressants.
DIF: Cognitive Level: Apply (application) REF: 1183
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which information is most important for the nurse to report to the health care provider
before a patient with type 2 diabetes is prepared for a coronary angiogram?
a. The patient’s most recent HbA1C was 6.5%.
b. The patient’s admission blood glucose is 128 mg/dL.
c. The patient took the prescribed metformin (Glucophage) today.
d. The patient took the prescribed captopril (Capoten) this morning.

ANS: C
To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram
and should not be used for 48 hours after IV contrast media are administered. The other patient data will
also be reported but do not indicate any need to reschedule the procedure.
DIF: Cognitive Level: Apply (application) REF: 1163
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which action by a patient indicates that the home health nurse’s teaching about
glargine and regular insulin has been successful?
a. The patient administers the glargine 30 minutes before each meal.
b. The patient’s family prefills the syringes with the mix of insulins weekly.
c. The patient draws up the regular insulin and then the glargine in the same syringe.
d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.

ANS: D
Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins
or prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is given
once daily.
DIF: Cognitive Level: Apply (application) REF: 1160
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

A 26-year-old patient with diabetes rides a bicycle to and from work every day. Which
site should the nurse teach the patient to administer the morning insulin?
a. thigh.
b. buttock.
c. abdomen.
d. upper arm.

ANS: C
Patients should be taught not to administer insulin into a site that will be exercised because exercise will
increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.
DIF: Cognitive Level: Apply (application) REF: 1160
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse is interviewing a new patient with diabetes who receives rosiglitazone
(Avandia) through a restricted access medication program. What is most important for the nurse to
report immediately to the health care provider?
a. The patient’s blood pressure is 154/92.
b. The patient has a history of emphysema.
c. The patient’s blood glucose is 86 mg/dL.
d. The patient has chest pressure when walking.

ANS: D
Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care
provider and expect orders to discontinue the medication. There is no urgent need to discuss the other data
with the health care provider.
DIF: Cognitive Level: Apply (application) REF: 1163
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

The nurse is taking a health history from a 29-year-old pregnant patient at the first
prenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic.
Which action will the nurse plan to take first?
a. Teach the patient about administering regular insulin.
b. Schedule the patient for a fasting blood glucose level.
c. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy.
d. Provide teaching about an increased risk for fetal problems with gestational
diabetes.

ANS: B
Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit.
An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the
twenty-fourth week. The other actions may also be needed (depending on whether the patient develops
gestational diabetes), but they are not the first actions that the nurse should take.
DIF: Cognitive Level: Apply (application) REF: 1157
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose
level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health
care provider should the nurse take first?
a. Place the patient on a cardiac monitor.
b. Administer IV potassium supplements.
c. Obtain urine glucose and ketone levels.
d. Start an insulin infusion at 0.1 units/kg/hr.

ANS: A
Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular
fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must
be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium.
Insulin should not be administered without cardiac monitoring because insulin infusion will further
decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the
patient’s care.
DIF: Cognitive Level: Apply (application) REF: 1176
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order
should the nurse implement first?
a. Infuse 1 liter of normal saline per hour.
b. Give sodium bicarbonate 50 mEq IV push.
c. Administer regular insulin 10 U by IV push.
d. Start a regular insulin infusion at 0.1 units/kg/hr.

ANS: A
The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the
priority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated.
DIF: Cognitive Level: Apply (application) REF: 1177
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

A female patient is scheduled for an oral glucose tolerance test. Which information
from the patient’s health history is most important for the nurse to communicate to the health care
provider?
a. The patient uses oral contraceptives.
b. The patient runs several days a week.
c. The patient has been pregnant three times.
d. The patient has a family history of diabetes.

ANS: A
Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. Exercise and a
family history of diabetes both can affect blood glucose but will not lead to misleading information from
the OGTT. History of previous pregnancies may provide informational about gestational glucose
tolerance, but will not lead to misleading information from the OGTT.
DIF: Cognitive Level: Apply (application) REF: 1157
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract
infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling
lightheaded and sweaty. Which action should the nurse take first?
a. Infuse dextrose 50% by slow IV push.
b. Administer 1 mg glucagon subcutaneously.
c. Obtain a glucose reading using a finger stick.
d. Have the patient drink 4 ounces of orange juice.

ANS: C
The patient’s clinical manifestations are consistent with hypoglycemia and the initial action should be to
check the patient’s glucose with a finger stick or order a stat blood glucose. If the glucose is low, the
patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might
be given if the patient’s symptoms become worse or if the patient is unconscious.
DIF: Cognitive Level: Apply (application) REF: 1179
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

Which laboratory value reported to the nurse by the unlicensed assistive personnel
(UAP) indicates the most urgent need for the nurse’s assessment of the patient?
a. Bedtime glucose of 140 mg/dL
b. Noon blood glucose of 52 mg/dL
c. Fasting blood glucose of 130 mg/dL
d. 2-hr postprandial glucose of 220 mg/dL

ANS: B
The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of
hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice. The other
values are within an acceptable range or not immediately dangerous for a diabetic patient.
DIF: Cognitive Level: Apply (application) REF: 1154
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing
action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
a. Communicate the blood glucose level and insulin dose to the circulating nurse in
surgery.
b. Discuss the reason for the use of insulin therapy during the immediate postoperative
period.
c. Administer the prescribed lispro (Humalog) insulin before transporting the patient
to surgery.
d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the
postoperative period.

ANS: C
LPN/LVN education and scope of practice includes administration of insulin. Communication about
patient status with other departments, planning, and patient teaching are skills that require RN education
and scope of practice.
DIF: Cognitive Level: Apply (application) REF: 1185
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment

An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic.
Which finding may indicate the need for a change in therapy?
a. Hemoglobin A1C level 6.2%
b. Blood pressure 146/88 mmHg
c. Heart rate at rest 58 beats/minute
d. High density lipoprotein (HDL) level 65 mg/dL

ANS: B
To decrease the incidence of macrovascular and microvascular problems in patients with diabetes, the
goal blood pressure is usually 130/80. An A1C less than 6.5%, a low resting heart rate (consistent with
regular aerobic exercise in a young adult), and an HDL level of 65 mg/dL all indicate that the patient’s
diabetes and risk factors for vascular disease are well controlled.
DIF: Cognitive Level: Apply (application) REF: 1181
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A 34-year-old has a new diagnosis of type 2 diabetes. The nurse will discuss the need
to schedule a dilated eye exam
a. every 2 years.
b. as soon as possible.
c. when the patient is 39 years old.
d. within the first year after diagnosis.

ANS: B
Because many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes,
a dilated eye exam is recommended at the time of diagnosis and annually thereafter. Patients with type 1
diabetes should have dilated eye exams starting 5 years after they are diagnosed and then annually.
DIF: Cognitive Level: Apply (application) REF: 1182
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

After the nurse has finished teaching a patient who has a new prescription for
exenatide (Byetta), which patient statement indicates that the teaching has been effective?
a. “I may feel hungrier than usual when I take this medicine.”
b. “I will not need to worry about hypoglycemia with the Byetta.”
c. “I should take my daily aspirin at least an hour before the Byetta.”
d. “I will take the pill at the same time I eat breakfast in the morning.”

ANS: C
Since exenatide slows gastric emptying, oral medications should be taken at least an hour before the
exenatide to avoid slowing absorption. Exenatide is injected and increases feelings of satiety.
Hypoglycemia can occur with this medication.
DIF: Cognitive Level: Apply (application) REF: 1165
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been
placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the
home health nurse makes a visit. Which finding by the nurse is most important to discuss with the
health care provider?
a. Hemoglobin A1C level is 7.9%.
b. Last eye exam was 18 months ago.
c. Glomerular filtration rate is decreased.
d. Patient has questions about the prescribed diet.

ANS: C
The decrease in renal function may indicate a need to adjust the dose of metformin or change to a
different medication. In older patients, the goal for A1C may be higher in order to avoid complications
associated with hypoglycemia. The nurse will plan on scheduling the patient for an eye exam and
addressing the questions about diet, but the biggest concern is the patient’s decreased renal function.
DIF: Cognitive Level: Apply (application) REF: 1186
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

The nurse has administered 4 oz of orange juice to an alert patient whose blood
glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should
the nurse take next?
a. Give the patient 4 to 6 oz more orange juice.
b. Administer the PRN glucagon (Glucagon) 1 mg IM.
c. Have the patient eat some peanut butter with crackers.
d. Notify the health care provider about the hypoglycemia.

ANS: A
The “rule of 15” indicates that administration of quickly acting carbohydrates should be done 2 to 3 times
for a conscious patient whose glucose remains less than 70 mg/dL before notifying the health care
provider. More complex carbohydrates and fats may be used once the glucose has stabilized. Glucagon
should be used if the patient’s level of consciousness decreases so that oral carbohydrates can no longer
be given.
DIF: Cognitive Level: Apply (application) REF: 1179
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)
who are working in the diabetic clinic?
a. Measure the ankle-brachial index.
b. Check for changes in skin pigmentation.
c. Assess for unilateral or bilateral foot drop.
d. Ask the patient about symptoms of depression.

ANS: A
Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is a
procedure that can be done by UAP who have been trained in the procedure. The other assessments
require more education and critical thinking and should be done by the registered nurse (RN).
DIF: Cognitive Level: Apply (application) REF: 15-16 | 1185
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment

After change-of-shift report, which patient will the nurse assess first?
a. 19-year-old with type 1 diabetes who was admitted with possible dawn
phenomenon
b. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230
mg/dL
c. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor
and dry oral mucosa
d. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and
complains of burning foot pain

ANS: C
The patient’s diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for
signs of shock and determine whether increased fluid infusion is needed. The other patients also need
assessment and intervention but do not have life-threatening complications.
DIF: Cognitive Level: Analyze (analysis) REF: 1178
OBJ: Special Questions: Multiple Patients; Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment

After change-of-shift report, which patient should the nurse assess first?
a. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
b. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
c. 40-year-old who is pregnant and whose oral glucose tolerance test is 202 mg/dL
d. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal
pain

ANS: B
Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness,
seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose. The other
patients also have symptoms that require assessments and/or interventions, but they are not at immediate
risk for life-threatening complications.
DIF: Cognitive Level: Analyze (analysis) REF: 1179
OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse
in the diabetic clinic schedule at least annually (select all that apply)?
a. Chest x-ray
b. Blood pressure
c. Serum creatinine
d. Urine for microalbuminuria
e. Complete blood count (CBC)
f. Monofilament testing of the foot

ANS: B, C, D, F
Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the
foot are recommended at least annually to screen for possible microvascular and macrovascular
complications of diabetes. Chest x-ray and CBC might be ordered if the diabetic patient presents with
symptoms of respiratory or infectious problems but are not routinely included in screening.
DIF: Cognitive Level: Apply (application) REF: 1161
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

In which order will the nurse take these steps to prepare NPH 20 units and regular
insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A,
B, C, D, E]).
a. Rotate NPH vial.
b. Withdraw regular insulin.
c. Withdraw 20 units of NPH.
d. Inject 20 units of air into NPH vial.
e. Inject 2 units of air into regular insulin vial.

ANS:
A, D, E, B, C
When mixing regular insulin with NPH, it is important to avoid contact between the regular insulin and
the additives in the NPH that slow the onset, peak, and duration of activity in the longer-acting insulin.
DIF: Cognitive Level: Understand (comprehension) REF: 1181
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

NEW BOOK

BRUNNER & SUDDARTH 14TH ED

A community health nurse has witnessed significant shifts in patterns of disease over the course of a
four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of
disease in the United States?
A) Type 1 diabetes management
B) Treatment of community-acquired pneumonia
C) Rehabilitation from traumatic brain injuries
D) Management of acute Staphylococcus aureus infections

Ans: A
Feedback:
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 12
Management of chronic diseases such as diabetes is a priority focus of the current health care
environment. This supersedes the treatment of acute infections and rehabilitation needs.

A nurse has been working with Mrs. Griffin, a 71-year-old patient whose poorly controlled type 1

diabetes has led to numerous health problems. Over the past several years Mrs. Griffin has had several

admissions to the hospital medical unit, and the nurse has often carried out health promotion

interventions. Who is ultimately responsible for maintaining and promoting Mrs. Griffins health?

1. A) The medical nurse
2. B) The community health nurse who has also worked with Mrs. Griffin
3. C) Mrs. Griffins primary care provider
4. D) Mrs. Griffin

Ans: D
Feedback:
American society places a great importance on health and the responsibility that each of us has to
maintain and promote our own health. Therefore, the other options are incorrect.

A 20-year-old man newly diagnosed with type 1 diabetes needs to learn how to self-administer insulin.
When planning the appropriate educational interventions and considering variables that will affect his
learning, the nurse should prioritize which of the following factors?

A) Patients expected lifespan
B) Patients gender
C) Patients occupation
D) Patients culture

Ans: D
Feedback:
One of the major variables that influences a patients readiness to learn is the patients culture, because it
affects how a person learns and what information is learned. Other variables include illness states,
values, emotional readiness, and physical readiness. Lifespan, occupation, and gender are variables that
are usually less salient.

You are the oncoming nurse and you have just taken end-of-shift report on your patients. One of your
patients newly diagnosed with diabetes was admitted with diabetic ketoacidosis. Which behavior best
demonstrates this patients willingness to learn?
A) The patient requests a visit from the hospitals diabetic educator.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 71
B) The patient sets aside a dessert brought in by a family member.
C) The patient wants a family member to meet with the dietician to discuss meals.
D) The patient readily allows the nurse to measure his blood glucose level.

Ans: A
Feedback:
Emotional readiness also affects the motivation to learn. A person who has not accepted an existing
illness or the threat of illness is not motivated to learn. The patients wiliness to learn is expressed
through the action of seeking information on his or her own accord. Seeking information shows an
emotional readiness to learn. The other options do not as clearly demonstrate a willingness to learn.

You are the clinic nurse providing patient education to a teenage girl who was diagnosed 6 months ago
with type 1 diabetes. Her hemoglobin A1C results suggest she has not been adhering to her prescribed
treatment regimen. As the nurse, what variables do you need to assess to help this patient better adhere
to her treatment regimen? Select all that apply.
A) Variables that affect the patients ability to obtain resources
B) Variables that affect the patients ability to teach her friends about diabetes
C) Variables that affect the patients ability to cure her disease
D) Variables that affect the patients ability to maintain a healthy social environment
E) Variables that affect the patients ability to adopt specific behaviors

Ans: A, D, E
Feedback:
Nurses success with health education is determined by ongoing assessment of the variables that affect a
patients ability to adopt specific behaviors, to obtain resources, and to maintain a healthy social
environment. The patients ability to teach her friends about her condition is not a variable that the nurse
would likely assess when educating the patient about her treatment regimen. Type 1 diabetes is not
curable.

Nurses who are providing patient education often use motivators for learning with patients who are
struggling with behavioral changes necessary to adhere to a treatment regimen. When working with a
15-year-old boy who has diabetes, which of the following motivators is most likely to be effective?
A) A learning contract
B) A star chart
C) A point system
D) A food-reward system

Ans: A
Feedback:
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 80
Using a learning contract or agreement can also be a motivator for learning. Such a contract is based on
assessment of patient needs; health care data; and specific, measurable goals. Young adults would not
respond well to the use of star charts, point systems, or food as reward for behavioral change. These
types of motivators would work better with children.

You are taking a health history on an adult patient who is new to the clinic. While performing your
assessment, the patient informs you that her mother has type 1 diabetes. What is the primary significance
of this information to the health history?
A) The patient may be at risk for developing diabetes.
B) The patient may need teaching on the effects of diabetes.
C) The patient may need to attend a support group for individuals with diabetes.
D) The patient may benefit from a dietary regimen that tracks glucose intake.

Ans: A
Feedback:
Nurses incorporate a genetics focus into the health assessments of family history to assess for geneticsrelated
risk factors. The information aids the nurse in determining if the patient may be predisposed to
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 85
diseases that are genetic in origin. The results of diabetes testing would determine whether dietary
changes, support groups or health education would be needed.

you are the nurse caring for a patient who is Native American who arrives at the clinic for treatment
related to type 2 diabetes. Which question would best provide you with information about the role of
food in the patients cultural practices and identify how the patients food preferences could be related to
his problem?
A) Do you feel any of your cultural practices have a negative impact on your disease process?
B) What types of foods are served as a part of your cultural practices, and how are they prepared?
C) As a nonnative, I am unaware of your cultural practices. Could you teach me a few practices that
may affect your care?
D) Tell me about foods that are important in your culture and how you feel they influence your
diabetes.

Ans: D
Feedback:
The beliefs and practices that have been shared from generation to generation are known as cultural or
ethnic patterns. Food plays a significant role in both cultural practices and type 2 diabetes. By asking the
question, Tell me about the foods that are important in your culture and how you feel they influence
your diabetes, the nurse demonstrates a cultural awareness to the client and allows an open-ended
discussion of the disease process and its relationship to cultural practice. An overemphasis on negatives
can inhibit assessment and communication. Assessing the types and preparation of foods specific to
cultural practices without relating it to diabetes is inadequate. The question, As a nonnative, I am
unaware of your cultural practices. Could you teach me a few practices that may affect your care?
focuses on care and fails to address the significance of food in cultural practice or diabetes.

You are the nurse caring for a 72-year-old woman who is recovering from a hemicolectomy on the
postsurgical unit. The surgery was very stressful and prolonged, and you note on the chart that her blood
sugars are elevated, yet diabetes does not appear in her previous medical history. To what do you
attribute this elevation in blood sugars?
A) It is a temporary result of increased secretion of antidiuretic hormone.
B) She must have had diabetes prior to surgery that was undiagnosed.
C) She has suffered pancreatic trauma during her abdominal surgery.
D) The blood sugars are probably a result of the fight-or-flight reaction.

Ans: D
Feedback:
During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which
creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to
glucose; the result is elevated blood sugars. Antidiuretic hormone is released during stressful situations
and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Assuming the
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 105
patient had diabetes prior to surgery demonstrates a lack of understanding of stress-induced
hyperglycemia. No evidence presented in the question other than elevated blood sugars would support a
diagnosis of diabetes.

The nurse is admitting a Native American patient with uncontrolled hypertension and type 1 diabetes to
the unit. During the initial assessment, the patient informs the nurse that he has been seeking assistance
and care from the shaman in his community. The nurse recognizes that the patients blood pressure and
his blood sugar level are elevated upon admission. What is the nurses best response to the patients
indication that his care provider is a shaman?
A) Thank you for providing the information about the shaman, but we will keep that information and
approach separate from your current hospitalization.
B) It seems that the care provided by your shaman is not adequately managing your hypertension and
diabetes, so we will try researched medical approaches.
C) Dont worry about insulting your shaman, as he will understand his approach to your hypertension
and diabetes was not working after your doctor tells him how sick you were in the hospital.
D) I understand that you value the care provided by the shaman, but we would like you to consider
medications and dietary changes that may lower your blood pressure and blood sugar levels.

Ans: D
Feedback:
Native American patients may seek assistance from a shaman or medicine man or woman. The nurses
best approach is not to disregard the patients belief in folk healers or try to undermine trust in the
healers. Nurses should make an effort to accommodate the patients beliefs while also advocating the
treatment proposed by health science. The nurses best response incorporating these strategies is, I
understand that you value the care provided by the shaman, but we would like you to consider
medications and dietary changes that may improve your blood pressure and blood sugar levels.

A medical-surgical nurse is teaching a patient about the health implications of her recently diagnosed
type 2 diabetes. The nurse should teach the patient to be proactive with her glycemic control in order to
reduce her risk of what health problem?
A) Arthritis
B) Renal failure
C) Pancreatic cancer
D) Asthma

Ans: B
Feedback:
One chronic disease can lead to the development of other chronic conditions. Diabetes, for example, can
eventually lead to neurologic and vascular changes that may result in visual, cardiac, and kidney disease
and erectile dysfunction. Diabetes is not often linked to cancer, arthritis, or asthma.

A patient has recently been diagnosed with type 2 diabetes. The patient is clinically obese and has a
sedentary lifestyle. How can the nurse best begin to help the patient increase his activity level?
A) Set up appointment times at a local fitness center for the patient to attend.
B) Have a family member ensure the patient follows a suggested exercise plan.
C) Construct an exercise program and have the patient follow it.
D) Identify barriers with the patient that inhibit his lifestyle change.

Ans: D
Feedback:
Nurses cannot expect that sedentary patients are going to develop a sudden passion for exercise and that
they will easily rearrange their day to accommodate time-consuming exercise plans. The patient may not
be ready or willing to accept this lifestyle change. This is why it is important that the nurse and patient
identify barriers to change.

You are caring for a young woman who has Down syndrome and who has just been diagnosed with type
2 diabetes. What consideration should you prioritize when planning this patients nursing care?
A) How her new diagnosis affects her health attitudes
B) How her diabetes affects the course of her Down syndrome
C) How her chromosomal disorder affects her glucose metabolism
D) How her developmental disability influences her health management

Ans: D
Feedback:
It is important to consider the interaction between existing disabilities and new diagnoses. Cognitive and
motor deficits would greatly affect diabetes management. Diabetes would not likely affect her attitude or
the course of her Down syndrome. Chromosomal disorders such as Down syndrome do not affect
glucose metabolism.

You are presenting patient teaching to a 48-year-old man who was just diagnosed with type 2 diabetes.
The patient has a BMI of 35 and leads a sedentary lifestyle. You give the patient information on the risk
factors for his diagnosis and begin talking with him about changing behaviors around diet and exercise.
You know that further patient teaching is necessary when your patient tells you what?
A) I need to start slow on an exercise program approved by my doctor.
B) I know theres a chance I could have avoided this if Id always eaten better and exercised more.
C) There is nothing that can be done anyway, because chronic diseases like diabetes cannot be
prevented.
D) I want to have a plan in place before I start making a lot of changes to my lifestyle.

Ans: C
Feedback:
The major causes of chronic diseases are known, and if these risk factors were eliminated, at least over
80% of heart disease, stroke, and type 2 diabetes would be prevented. In addition, over 40% of cancers
would be prevented. The other listed options are accurate statements.

The nurse admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnel
surgery. How should this patients diagnosis of type 1 diabetes affect the care that the nurse plans?
A) The nurse should administer a bolus of dextrose IV solution preoperatively.
B) The nurse should keep the patient NPO for at least 8 hours preoperatively.
C) The nurse should initiate a subcutaneous infusion of long-acting insulin.
D) The nurse should assess the patients blood glucose levels vigilantly.

Ans: D
Feedback:
The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia.
Close glycemic monitoring is necessary. Dextrose infusion and prolonged NPO status are
contraindicated. There is no specific need for an insulin infusion preoperatively.

The nurse is planning the care of a patient who has type 1 diabetes and who will be undergoing knee
replacement surgery. This patients care plan should reflect an increased risk of what postsurgical
complications? Select all that apply.
A) Hypoglycemia
B) Delirium
C) Acidosis
D) Glucosuria
E) Fluid overload

Ans: A, C, D
Feedback:
Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or
excessive administration of insulin. Hyperglycemia, which can increase the risk for surgical wound
infection, may result from the stress of surgery, which can trigger increased levels of catecholamine.
Other risks are acidosis and glucosuria. Risks of fluid overload and delirium are not normally increased.

The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever she walks
several blocks. The patient has type 1 diabetes and has smoked a pack of cigarettes every day for the
past 40 years. The physician diagnoses intermittent claudication. The nurse should provide what
instruction about long-term care to the client?
A) Be sure to practice meticulous foot care.
B) Consider cutting down on your smoking.
C) Reduce your activity level to accommodate your limitations.
D) Try to make sure you eat enough protein.

Ans: A

Feedback:

The patient with peripheral vascular disease or diabetes should receive education or reinforcement about

skin and foot care. Intermittent claudication and other chronic peripheral vascular diseases reduce

oxygenation to the feet, making them susceptible to injury and poor healing; therefore, meticulous foot

care is essential. The patient should stop smokingnot just cut downbecause nicotine is a vasoconstrictor.

Daily walking benefits the patient with intermittent claudication. Increased protein intake will not

alleviate the patients symptoms.

A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia.
When reviewing this patients treatment plan, the nurse should anticipate the use of what drug?
A) Magnesium sulfate
B) Epoetin alfa
C) Low-molecular weight heparin
D) Vitamin K

Ans: B
Feedback:
The availability of recombinant erythropoietin (epoetin alfa [Epogen, Procrit], darbepoetin alfa
[Aranesp]) has dramatically altered the management of anemia in end-stage renal disease. Heparin,
vitamin K, and magnesium are not indicated in the treatment of renal failure or the consequent anemia.

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive.
What is the nurses most plausible conclusion based on this assessment finding?
A) The patient should withhold his next scheduled dose of insulin.
B) The patient should promptly eat some protein and carbohydrates.
C) The patients insulin levels are inadequate.
D) The patient would benefit from a dose of metformin (Glucophage).

Ans: C
Feedback:
Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is
deteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin
will not cause short-term resolution of hyperglycemia.

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would
support checking blood levels for the diagnosis of diabetes?
A) Fasting plasma glucose greater than or equal to 126 mg/dL
B) Random plasma glucose greater than 150 mg/dL
C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
D) Random plasma glucose greater than 126 mg/dL

Ans: A
Feedback:
Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater
than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline
would be important to teach the patients at this class?
A) Low fat generally indicates low sugar.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 960
B) Protein should constitute 30% to 40% of caloric intake.
C) Most calories should be derived from carbohydrates.
D) Animal fats should be eliminated from the diet.

Ans: C
Feedback:
Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic
Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived
from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not
automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus
and her family. The nurse teaches the patient and family that which of the following nonpharmacologic
measures will decrease the bodys need for insulin?
A) Adequate sleep
B) Low stimulation
C) Exercise
D) Low-fat diet

Ans: C
Feedback:
Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride
levels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate
sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.

A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration
record includes the administration of regular insulin three times daily. Knowing that the patients lunch
tray will arrive at 11:45, when should the nurse administer the patients insulin?
A) 10:45
B) 11:15
C) 11:45
D) 11:50

Ans: B
Feedback:
Regular insulin is usually administered 2030 min before a meal. Earlier administration creates a risk for
hypoglycemia; later administration creates a risk for hyperglycemia.

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic
agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood
glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?
A) A sulfonylurea
B) A biguanide
C) A thiazolidinedione
D) An alpha glucosidase inhibitor

Ans: B
Feedback:
Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and
therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by
the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance
insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas.
Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system,
resulting in a lower postprandial blood glucose level.

A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What
guideline applies to periods of illness in a diabetic patient?
A) Do not eliminate insulin when nauseated and vomiting.
B) Report elevated glucose levels greater than 150 mg/dL.
C) Eat three substantial meals a day, if possible.
D) Reduce food intake and insulin doses in times of illness.

Ans: A
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 962
Feedback:
The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses
when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent
dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels
will rise but should be reported if they are greater than 300 mg/dL.

The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address
what topic during this dialogue?
A) The need for frequent eye examinations for patients with diabetes
B) The fact that patients with diabetes have an elevated risk of myocardial infarction
C) The relationship between kidney function and blood glucose levels
D) The need to monitor urine for the presence of albumin

Ans: B
Feedback:
Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the
effects on vision and renal function are considered to be microvascular.

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the
following actions has the greatest potential to reduce an individuals risk for developing diabetes?
A) Have blood glucose levels checked annually.
B) Stop using tobacco in any form.
C) Undergo eye examinations regularly.
D) Lose weight, if obese.

Ans: D
Feedback:
Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease.
Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not
screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.

A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 963
subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are being
destroyed, the patient would be diagnosed with what type of diabetes?
A) Type 1 diabetes
B) Type 2 diabetes
C) Noninsulin-dependent diabetes
D) Prediabetes

Ans: A
Feedback:
Beta cell destruction is the hallmark of type 1 diabetes. Noninsulin-dependent diabetes is synonymous
with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell
destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of
hyperglycemia, often during illness or pregnancy.

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse
is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your
blood increase.
B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is
not enough insulin to control it.
C) The amount of glucose that your body makes overwhelms your pancreas and decreases your
production of insulin.
D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels
rise because insulin normally breaks it down.

Ans: D
Feedback:
Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin
production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose
derived from food cannot be stored in the liver and remains circulating in the blood, which leads to
postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion.
The body does not make glucose.

An occupational health nurse is screening a group of workers for diabetes. What statement should the
nurse interpret as suggestive of diabetes?
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 964
A) Ive always been a fan of sweet foods, but lately Im turned off by them.
B) Lately, I drink and drink and cant seem to quench my thirst.
C) No matter how much sleep I get, it seems to take me hours to wake up.
D) When I went to the washroom the last few days, my urine smelled odd.

Ans: B
Feedback:
Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia.
Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for
levels of caloric intake. What do the ADAs recommendations include?
A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60%
from protein
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 965
C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20%
from protein
D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20%
from protein

Ans: D
Feedback:
Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic
Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from
carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient
understands the primary treatment for type 2 diabetes when the patient states what?
A) I read that a pancreas transplant will provide a cure for my diabetes.
B) I will take my oral antidiabetic agents when my morning blood sugar is high.
C) I will make sure to follow the weight loss plan designed by the dietitian.
D) I will make sure I call the diabetes educator when I have questions about my insulin.

Ans: C
Feedback:
Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss.
Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose
levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory
levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on
a temporary basis during times of acute psychological stress, but it is not the central component of type 2
treatment. Pancreas transplantation is associated with type 1 diabetes.

An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The
patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the
patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of
hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?
A) Administration of antihypertensive medications
B) Administering sodium bicarbonate intravenously
C) Reversing acidosis by administering insulin
D) Fluid and electrolyte replacement

Ans: D
Feedback:
The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and
insulin administration. Antihypertensive medications are not indicated, as hypotension generally
accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as
their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the
treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the
best way to assess the patients ability to prepare and self-administer insulin?
A) Ask the patient to describe the process in detail.
B) Observe the patient drawing up and administering the insulin.
C) Provide a health education session reviewing the main points of insulin delivery.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 966
D) Review the patients first hemoglobin A1C result after discharge.

Ans: B
Feedback:
Nurses should assess the patients ability to perform diabetes related self-care as soon as possible during
the hospitalization or office visit to determine whether the patient requires further diabetes teaching.
While consulting a home care nurse is beneficial, an initial assessment should be performed during the
hospitalization or office visit. Nurses should directly observe the patient performing the skills such as
insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the
patient about these skills without actually observing performance of the skill is not sufficient. Further
education does not guarantee learning.

An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about
foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot
care is extremely important. Why would the nurse feel that foot care is so important to this patient?
A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
B) Avoiding foot ulcers may mean the difference between institutionalization and continued
independent living.
C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
D)
Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower
extremities.

Ans: B
Feedback:
The nurse recognizes that providing information on the long-term complicationsespecially foot and eye
problemsassociated with diabetes is important. Avoiding amputation through early detection of foot
ulcers may mean the difference between institutionalization and continued independent living for the
elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and
may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in
circulation is related to vascular changes and is not associated with drugs administered for diabetes.

A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is
aware that the patient will require further teaching when the patient states what?
A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar
every 2 hours.
B) If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a
day.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 967
C) I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea.
D) I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.

Ans: A
Feedback:
The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin when
sick. The nurse should emphasize that the patient should take insulin agents as usual and test ones blood
sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental
doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater
than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to
eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding.
If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60
minutes to prevent dehydration.

Which of the following patients with type 1 diabetes is most likely to experience adequate glucose
control?
A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
B) A patient who never deviates from her prescribed dose of insulin
C) A patient who adheres closely to a meal plan and meal schedule
D) A patient who eliminates carbohydrates from his daily intake

Ans: C
Feedback:
The therapeutic goal for diabetes management is to achieve normal blood glucose levels without
hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the
treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by
patients. For patients who require insulin to help control blood glucose levels, maintaining consistency
in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the
approximate time intervals between meals, and the snacks, help maintain overall glucose control.
Skipping meals is never advisable for person with type 1 diabetes.

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance
test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is
conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should
explain that gestational diabetes is a result of what etiologic factor?
A) Increased caloric intake during the first trimester
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 968
B) Changes in osmolality and fluid balance
C) The effects of hormonal changes during pregnancy
D) Overconsumption of carbohydrates during the first two trimesters

Ans: C
Feedback:
Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of
placental hormones, which causes insulin resistance. The disease is not the result of food intake or
changes in osmolality.

A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic
hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome
most often occur?
A) Patients who are obese and who have no known history of diabetes
B) Patients with type 1 diabetes and poor dietary control
C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Ans: D
Feedback:
HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or
who have type 2 diabetes.

A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient
about self-administration of insulin in the home setting. The nurse should teach the patient to do which
of the following?
A) Avoid using the same injection site more than once in 2 to 3 weeks.
B) Avoid mixing more than one type of insulin in a syringe.
C) Cleanse the injection site thoroughly with alcohol prior to injecting.
D) Inject at a 45 angle.

Ans: A
Feedback:
To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks.
Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is
usually inserted at a 90 angle. Cleansing the injection site with alcohol is optional.

A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being
admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on
two occasions. The nurse would identify what likely cause for this short-term change in treatment?
A) Alterations in bile metabolism and release have likely caused hyperglycemia.
B) Stress has likely caused an increase in the patients blood sugar levels.
C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic
measures.
D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

Ans: B
Feedback:
During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because
levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone)
increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of
previous blood sugar control, or fluid imbalance.

A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later
that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best
response?
A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have
gone on for years.
B) The cause is not known for sure but it is thought to have something to do with ketoacidosis.
C) The cause is not known for sure but it is thought to involve elevated blood glucose levels over a
period of years.
D) Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels
and elevated ketone levels.

Ans: C
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 970
Feedback:
The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High
blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible.
Ketones and ketoacidosis are not direct causes of neuropathies.

A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin
(Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should
prioritize which of the following assessments?
A) Monitoring the patients neutrophil levels
B) Assessing the patient for signs of impaired liver function
C) Monitoring the patients level of consciousness and behavior
D) Reviewing the patients creatinine and BUN levels

Ans: D
Feedback:
Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patients renal
function. This drug does not typically affect patients neutrophils, liver function, or cognition.

A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The
nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy.
Peripheral neuropathy constitutes a risk for what nursing diagnosis?
A) Infection
B) Acute pain
C) Acute confusion
D) Impaired urinary elimination

Ans: A
Feedback:
Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury
and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not
normally result in pain, confusion, or impairments in urinary function.

A patient has been brought to the emergency department by paramedics after being found unconscious.
The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients blood
glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?
A) IV administration of 50% dextrose in water
B) Subcutaneous administration of 10 units of Humalog
C) Subcutaneous administration of 12 to 15 units of regular insulin
D) IV bolus of 5% dextrose in 0.45% NaCl

Ans: A
Feedback:
In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50
mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five
percent dextrose would be inadequate and insulin would exacerbate the patients condition.

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing
information on the prevention and management of hypoglycemia, what action should the nurse promote?
A) Always carry a form of fast-acting sugar.
B) Perform exercise prior to eating whenever possible.
C) Eat a meal or snack every 8 hours.
D) Check blood sugar at least every 24 hours.

Ans: A
Feedback:
The following teaching points should be included in information provided to the patient on how to
prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a
meal or snack every 4 to 5 hours, and check blood sugar regularly.

A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic
should the nurse address?
A) Signs and symptoms of diabetic nephropathy
B) Management of diabetic ketoacidosis
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 972
C) Effects of surgery and pregnancy on blood sugar levels
D) Recognition of hypoglycemia and hyperglycemia

Ans: D
Feedback:
It is imperative that newly diagnosed patients know the signs and symptoms and management of hypoand
hyperglycemia. The other listed topics are valid points for education, but are not components of the
patients immediate survival skills following a new diagnosis.

A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of
insulin can be stored at room temperature before it goes bad. What would be the nurses best answer?
A) If you are going to use up the vial within 1 month it can be kept at room temperature.
B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature.
C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature.
D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature.

Ans: A
Feedback:
If a vial of insulin will be used up within 1 month, it may be kept at room temperature.

A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the
patient and will implement a program of health education. What is the nurses priority action?
A)
Ensure that the patient understands the basic pathophysiology of diabetes.
B) Identify the patients body mass index.
C) Teach the patient survival skills for diabetes.
D) Assess the patients readiness to learn.

Ans: D
Feedback:
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 973
Before initiating diabetes education, the nurse assesses the patients (and familys) readiness to learn. This
must precede other physiologic assessments (such as BMI) and providing health education.

A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses
the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8
mmol/L). What should the school nurse administer?
A) A combination of protein and carbohydrates, such as a small cup of yogurt
B) Two teaspoons of sugar dissolved in a cup of apple juice
C) Half of a cup of juice, followed by cheese and crackers
D) Half a sandwich with a protein-based filling

Ans: C
Feedback:
Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose
tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack
including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is
unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in
juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may
result in a sharp rise in blood sugar that will last for several hours.

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for
diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase
of treatment?
A) Monitoring the patient for dysrhythmias
B) Maintaining and monitoring the patients fluid balance
C) Assessing the patients level of consciousness
D) Assessing the patient for signs and symptoms of venous thromboembolism

Ans: B
Feedback:
In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration,
electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor
the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance
is the highest priority.

A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is
likely to have minimal contact with the health care system. In order to ensure that the patient maintains
adequate blood sugar control over the long term, the nurse should recommend which of the following?
A) Participation in a support group for persons with diabetes
B) Regular consultation of websites that address diabetes management
C) Weekly telephone check-ins with an endocrinologist
D) Participation in clinical trials relating to antihyperglycemics

Ans: A
Feedback:
Participation in support groups is encouraged for patients who have had diabetes for many years as well
as for those who are newly diagnosed. This is more interactive and instructive than simply consulting
websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation
in research trials may or may not be beneficial and appropriate, depending on patients circumstances.

A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority
instruction for the nurse to give the patient?
A) Examine feet weekly for redness, blisters, and abrasions.
B) Avoid the use of moisturizing lotions.
C) Avoid hot-water bottles and heating pads.
D) Dry feet vigorously after each bath.

Ans: C
Feedback:
High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes,
soaking the feet, and shaving calluses, should be avoided.
Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling,
redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After
a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.

A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most
appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?
A) Ask the patient to describe an optimally healthy meal.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 975
B) Ask the patient to keep a food diary and review it with the nurse.
C) Ask the patients family what he typically eats.
D) Ask the patient to describe a typical days food intake.

Ans: B
Feedback:
Reviewing the patients actual food intake is the most accurate method of gauging the patients diet.

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the
presence of microalbuminuria. What is the nurses most appropriate action?
A) Teach the patient about actions to slow the progression of nephropathy.
B) Ensure that the patient receives a comprehensive assessment of liver function.
C) Determine whether the patient has been using expired insulin.
D) Administer a fluid challenge and have the test repeated.

Ans: A
Feedback:
Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such,
educational interventions addressing this microvascular complication are warranted. Expired insulin
does not cause nephropathy, and the patients liver function is not likely affected. There is no indication
for the use of a fluid challenge.

A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse
should question the patient about what sign or symptom that would suggest the possible development of
peripheral neuropathy?
A) Persistently cold feet
B) Pain that does not respond to analgesia
C) Acute pain, unrelieved by rest
D) The presence of a tingling sensation

Ans: D
Feedback:
Although approximately half of patients with diabetic neuropathy do not have symptoms, initial
symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations
(especially at night). Cold and intense pain are atypical early signs of this complication.

A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular
dose of insulin. What else should the nurse tell the patient?
A) Make sure to stick to your normal diet.
B) Try to eat small amounts of carbs, if possible.
C) Ensure that you check your blood glucose every hour.
D) For now, check your urine for ketones every 8 hours.

Ans: B
Feedback:
For prevention of DKA related to illness, the patient should attempt to consume frequent small portions
of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking
fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed
every 3 to 4 hours.

A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and
is experiencing HHS. The nurse should identify what components of HHS? Select all that apply.
A) Leukocytosis
B) Glycosuria
C) Dehydration
D) Hypernatremia
E) Hyperglycemia

Ans: B, C, D, E
Feedback:
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 977
In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and
electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the
extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity
occur. Leukocytosis does not take place.

B&S

left off at pg 979

NEW BOOK

IGNATAVICIUS 9TH ED

A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my blood
glucose levels no lower than about 60 mg/dL? How should the nurse respond?
a. Glucose is the only fuel used by the body to produce the energy that it needs.
b. Your brain needs a constant supply of glucose because it cannot store it.
c. Without a minimum level of glucose, your body does not make red blood cells.
d. Glucose in the blood prevents the formation of lactic acid and prevents
acidosis.

ANS: B
Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the
bodys circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to
educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein,
and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose
metabolism but is not directly responsible for lactic acid formation.
DIF:Remembering/Knowledge REF: 1281
KEY: Diabetes mellitus| hypoglycemia MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy,
and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clients
polyuria?
a. Serum sodium: 163 mEq/L
b. Serum creatinine: 1.6 mg/dL
c. Presence of urine ketone bodies
d. Serum osmolarity: 375
mOsm/kg

ANS: D
Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis.
The clients serum osmolarity is high. The clients sodium would be expected to be high owing to dehydration.
Serum creatinine and urine ketone bodies are not related to the polyuria.
DIF:Applying/Application REF: 1282
KEYiabetes mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses
the clients understanding. Which statement made by the client indicates a correct understanding of the need for
eye examinations?
a. At my age, I should continue seeing the ophthalmologist as I usually do.
b. I will see the eye doctor when I have a vision problem and yearly after age
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 527
40.
c. My vision will change quickly. I should see the ophthalmologist twice a year.
d. Diabetes can cause blindness, so I should see the ophthalmologist yearly.

ANS: D
Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of
age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at
least yearly thereafter.
DIF:Applying/Application REF: 1283
KEY: Diabetes mellitus| health screening MSC: Integrated Process: Teaching/Learning
NOT:Client Needs Category: Health Promotion

A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both
feet. Which action should the nurse take first?
a. Document the finding in the clients chart.
b. Assess tactile sensation in the clients
hands.
c. Examine the clients feet for signs of injury.
d. Notify the health care provider.

ANS: C
Diabetic neuropathy is common when the disease is of long duration. The client is at great risk for injury in any
area with decreased sensation because he or she is less able to feel injurious events. Feet are common locations
for neuropathy and injury, so the nurse should inspect them for any signs of injury. After assessment, the nurse
should document findings in the clients chart. Testing sensory perception in the hands may or may not be
needed. The health care provider can be notified after assessment and documentation have been completed.
DIF:Applying/Application REF: 1301
KEYiabetes mellitus| neuropathy
MSC:Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse cares for a client who has a family history of diabetes mellitus. The client states, My father has type
1 diabetes mellitus. Will I develop this disease as well? How should the nurse respond?
a. Your risk of diabetes is higher than the general population, but it may not
occur.
b. No genetic risk is associated with the development of type 1 diabetes mellitus.
c. The risk for becoming a diabetic is 50% because of how it is inherited.
d. Female children do not inherit diabetes mellitus, but male children will.

ANS: A
Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types.
Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1)
seems to require interaction between inherited risk and environmental factors, so not everyone with these genes
develops diabetes. The other statements are not accurate.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 528
DIF:Understanding/Comprehension REF: 1287
KEY: Diabetes mellitus| genetics MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include
in this clients plan of care to delay the onset of microvascular and macrovascular complications?
a. Maintain tight glycemic control and prevent
hyperglycemia.
b. Restrict your fluid intake to no more than 2 liters a day.
c. Prevent hypoglycemia by eating a bedtime snack.
d. Limit your intake of protein to prevent ketoacidosis.

ANS: A
Hyperglycemia is a critical factor in the pathogenesis of long-term diabetic complications. Maintaining tight
glycemic control will help delay the onset of complications. Restricting fluid intake is not part of the treatment
plan for clients with diabetes. Preventing hypoglycemia and ketosis, although important, are not as important
as maintaining daily glycemic control.
DIF:Applying/Application REF: 1281
KEY: Diabetes mellitus| hyperglycemia MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest risk?
a. A 29-year-old Caucasian
b. A 32-year-old African-
American
c. A 44-year-old Asian
d. A 48-year-old American Indian

ANS: D
Diabetes is a particular problem among African Americans, Hispanics, and American Indians. The incidence
of diabetes increases in all races and ethnic groups with age. Being both an American Indian and middle-aged
places this client at highest risk.
DIF:Understanding/Comprehension REF: 1287
KEYiabetes mellitus| health screening
MSC:Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse
include in this clients teaching to prevent bloodborne infections?
a. Wash your hands after completing each test.
b. Do not share your monitoring equipment.
c. Blot excess blood from the strip with a cotton
ball.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 529
d. Use gloves when monitoring your blood glucose.

ANS: B
Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to
another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to
avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands
before testing. The client would not need to blot excess blood away from the strip or wear gloves.
DIF:Applying/Application REF: 1298
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which
statement should the nurse include in this clients teaching?
a. Change positions slowly when you get out of bed.
b. Avoid taking nonsteroidal anti-inflammatory drugs
(NSAIDs).
c. If you miss a dose of this drug, you can double the next dose.
d. Discontinue the medication if you develop a urinary infection.

ANS: B
NSAIDs potentiate the hypoglycemic effects of sulfonylurea agents. Glipizide is a sulfonylurea. The other
statements are not applicable to glipizide.
DIF:Applying/Application REF: 1290
KEYiabetes mellitus| oral antidiabetic agents| medication safety
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

After teaching a client with type 2 diabetes mellitus who is prescribed nateglinide (Starlix), the nurse
assesses the clients understanding. Which statement made by the client indicates a correct understanding of the
prescribed therapy?
a. Ill take this medicine during each of my meals.
b. I must take this medicine in the morning when I
wake.
c. I will take this medicine before I go to bed.
d. I will take this medicine immediately before I eat.

ANS: D
Nateglinide is an insulin secretagogue that is designed to increase meal-related insulin secretion. It should be
taken immediately before each meal. The medication should not be taken without eating as it will decrease the
clients blood glucose levels. The medication should be taken before meals instead of during meals.
DIF:Applying/Application REF: 1292
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 530
KEYiabetes mellitus| oral antidiabetic agents| medication safety
MSC:Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client
reports that his urine has become darker since starting the medication. Which action should the nurse take?
a. Assess for pain or burning with urination.
b. Review the clients liver function study
results.
c. Instruct the client to increase water intake.
d. Test a sample of urine for occult blood.

ANS: B
Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the
start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one
indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse
should check the clients most recent liver function studies. The nurse does not need to assess for pain or
burning with urination and does not need to check the urine for occult blood. The client does not need to be
told to increase water intake.
DIF:Applying/Application REF: 1292
KEYiabetes mellitus| oral antidiabetic agents| medication safety
MSC:Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse cares for a client with diabetes mellitus who asks, Why do I need to administer more than one
injection of insulin each day? How should the nurse respond?
a. You need to start with multiple injections until you become more proficient at self-injection.
b. A single dose of insulin each day would not match your blood insulin levels and your food intake patterns.
c. A regimen of a single dose of insulin injected each day would require that you eat fewer carbohydrates.
d. A single dose of insulin would be too large to be absorbed, predictably putting you at risk for insulin
shock.

ANS: B
Even when a single injection of insulin contains a combined dose of different-acting insulin types, the timing
of the actions and the timing of food intake may not match well enough to prevent wide variations in blood
glucose levels. One dose of insulin would not be appropriate even if the client decreased carbohydrate intake.
Additional injections are not required to allow the client practice with injections, nor will one dose increase the
clients risk of insulin shock.
DIF:Applying/Application REF: 1294
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

After teaching a client with diabetes mellitus to inject insulin, the nurse assesses the clients understanding.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 531
Which statement made by the client indicates a need for additional teaching?
a. The lower abdomen is the best location because it is closest to the pancreas.
b. I can reach my thigh the best, so I will use the different areas of my thighs.
c. By rotating the sites in one area, my chance of having a reaction is decreased.
d. Changing injection sites from the thigh to the arm will change absorption
rates.

ANS: A
The abdominal site has the fastest rate of absorption because of blood vessels in the area, not because of its
proximity to the pancreas. The other statements are accurate assessments of insulin administration.
DIF:Applying/Application REF: 1294
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse assesses a client with diabetes mellitus and notes the client only responds to a sternal rub by
moaning, has capillary blood glucose of 33 g/dL, and has an intravenous line that is infiltrated with 0.45%
normal saline. Which action should the nurse take first?
a. Administer 1 mg of intramuscular glucagon.
b. Encourage the client to drink orange juice.
c. Insert a new intravenous access line.
d. Administer 25 mL dextrose 50% (D50) IV
push.

ANS: A
The clients blood glucose level is dangerously low. The nurse needs to administer glucagon IM immediately to
increase the clients blood glucose level. The nurse should insert a new IV after administering the glucagon and
can use the new IV site for future doses of D50 if the clients blood glucose level does not rise. Once the client
is awake, orange juice may be administered orally along with a form of protein such as a peanut butter.
DIF:Applying/Application REF: 1301
KEYiabetes mellitus| hypoglycemia
MSC:Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, Can I ask my
niece to prefill my syringes and then store them for later use when I need them? How should the nurse
respond?
a. Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle
pointing up.
b. Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light.
c. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes.
d. No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container.

: A
Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic
syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the
needle pointing up to prevent suspended insulin particles from clogging the needle.
DIF:Remembering/Knowledge REF: 1296
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse teaches a client who is prescribed an insulin pump. Which statement should the nurse include in
this clients discharge education?
a. Test your urine daily for ketones.
b. Use only buffered insulin in your pump.
c. Store the insulin in the freezer until you need
it.
d. Change the needle every 3 days.

ANS: D
Having the same needle remain in place through the skin for longer than 3 days drastically increases the risk
for infection in or through the delivery system. Having an insulin pump does not require the client to test for
ketones in the urine. Insulin should not be frozen. Insulin is not buffered.
DIF:Applying/Application REF: 1295
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

After teaching a client who has diabetes mellitus and proliferative retinopathy, nephropathy, and peripheral
neuropathy, the nurse assesses the clients understanding. Which statement made by the client indicates a
correct understanding of the teaching?
a. I have so many complications; exercising is not recommended.
b. I will exercise more frequently because I have so many
complications.
c. I used to run for exercise; I will start training for a marathon.
d. I should look into swimming or water aerobics to get my exercise.

ANS: D
Exercise is not contraindicated for this client, although modifications based on existing pathology are
necessary to prevent further injury. Swimming or water aerobics will give the client exercise without the worry
of having the correct shoes or developing a foot injury. The client should not exercise too vigorously.
DIF:Applying/Application REF: 1298
KEY: Diabetes mellitus| exercise MSC: Integrated Process: Teaching/Learning
NOT:Client Needs Category: Health Promotion and Maintenance

An emergency department nurse assesses a client with ketoacidosis. Which clinical manifestation should
the nurse correlate with this condition?
a. Increased rate and depth of respiration
b. Extremity tremors followed by seizure
activity
c. Oral temperature of 102 F (38.9 C)
d. Severe orthostatic hypotension

ANS: A
Ketoacidosis decreases the pH of the blood, stimulating the respiratory control areas of the brain to buffer the
effects of increasing acidosis. The rate and depth of respiration are increased (Kussmaul respirations) in an
attempt to excrete more acids by exhalation. Tremors, elevated temperature, and orthostatic hypotension are
not associated with ketoacidosis.
DIF:Applying/Application REF: 1313
KEYiabetes mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse assesses a client who has diabetes mellitus. Which arterial blood gas values should the nurse
identify as potential ketoacidosis in this client?
a. pH 7.38, HCO3 22 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg
b. pH 7.28, HCO3 18 mEq/L, PCO2 28 mm Hg, PO2 98 mm Hg
c. pH 7.48, HCO3 28 mEq/L, PCO2 38 mm Hg, PO2 98 mm Hg
d. pH 7.32, HCO3 22 mEq/L, PCO2 58 mm Hg, PO2 88 mm Hg

ANS: B
When the lungs can no longer offset acidosis, the pH decreases to below normal. A client who has diabetic
ketoacidosis would present with arterial blood gas values that show primary metabolic acidosis with decreased
bicarbonate levels and a compensatory respiratory alkalosis with decreased carbon dioxide levels.
DIF:Applying/Application REF: 1313
KEYiabetes mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations.
Which action should the nurse take?
a. Administration of oxygen via face mask
b. Intravenous administration of 10%
glucose
c. Implementation of seizure precautions

d. Administration of intravenous insulin

ANS: D
The rapid, deep respiratory efforts of Kussmaul respirations are the bodys attempt to reduce the acids produced
by using fat rather than glucose for fuel. Only the administration of insulin will reduce this type of respiration
by assisting glucose to move into cells and to be used for fuel instead of fat. The client who is in ketoacidosis
may not experience any respiratory impairment and therefore does not need additional oxygen. Giving the
client glucose would be contraindicated. The client does not require seizure precautions.
DIF:Applying/Application REF: 1313
KEYiabetes mellitus| hyperglycemia| respiratory distress/failure
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse cares for a client who has type 1 diabetes mellitus. The client asks, Is it okay for me to have an
occasional glass of wine? How should the nurse respond?
a. Drinking any wine or alcohol will increase your insulin requirements.
b. Because of poor kidney function, people with diabetes should avoid
alcohol.
c. You should not drink alcohol because it will make you hungry and overeat.
d. One glass of wine is okay with a meal and is counted as two fat exchanges.

ANS: D
Under normal circumstances, blood glucose levels will not be affected by moderate use of alcohol when
diabetes is well controlled. Because alcohol can induce hypoglycemia, it should be ingested with or shortly
after a meal. One alcoholic beverage is substituted for two fat exchanges when caloric intake is calculated.
Kidney function is not impacted by alcohol intake. Alcohol is not associated with increased hunger or
overeating.
DIF:Applying/Application REF: 1300
KEYiabetes mellitus| nutritional requirements
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

A nurse teaches a client with type 1 diabetes mellitus. Which statement should the nurse include in this
clients teaching to decrease the clients insulin needs?
a. Limit your fluid intake to 2 liters a day.
b. Animal organ meat is high in insulin.
c. Limit your carbohydrate intake to 80 grams a
day.
d. Walk at a moderate pace for 1 mile daily.

ANS: D
Moderate exercise such as walking helps regulate blood glucose levels on a daily basis and results in lowered
insulin requirements for clients with type 1 diabetes mellitus. Restricting fluids and eating organ meats will not
reduce insulin needs. People with diabetes need at least 130 grams of carbohydrates each day.
DIF:Applying/Application REF: 1318

A nurse cares for a client who is diagnosed with acute rejection 2 months after receiving a simultaneous
pancreas-kidney transplant. The client states, I was doing so well with my new organs, and the thought of
having to go back to living on hemodialysis and taking insulin is so depressing. How should the nurse respond?
a. Following the drug regimen more closely would have prevented this.
b. One acute rejection episode does not mean that you will lose the new organs.
c. Dialysis is a viable treatment option for you and may save your life.
d. Since you are on the national registry, you can receive a second
transplantation.

ANS: B
An episode of acute rejection does not automatically mean that the client will lose the transplant.
Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow
the graft to be maintained. The other statements either belittle the client or downplay his or her concerns. The
client may not be a candidate for additional organ transplantation.
DIF:Applying/Application REF: 1304
KEYiabetes mellitus| pancreas-kidney transplant
MSC:Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity

After teaching a client who is recovering from pancreas transplantation, the nurse assesses the clients
understanding. Which statement made by the client indicates a need for additional education?
a. If I develop an infection, I should stop taking my corticosteroid.
b. If I have pain over the transplant site, I will call the surgeon
immediately.
c. I should avoid people who are ill or who have an infection.
d. I should take my cyclosporine exactly the way I was taught.

ANS: A
Immunosuppressive agents should not be stopped without the consultation of the transplantation physician,
even if an infection is present. Stopping immunosuppressive therapy endangers the transplanted organ. The
other statements are correct. Pain over the graft site may indicate rejection. Anti-rejection drugs cause
immunosuppression, and the client should avoid crowds and people who are ill. Changing the routine of antirejection
medications may cause them to not work optimally.
DIF:Applying/Application REF: 1303
KEYiabetes mellitus| pancreas-kidney transplant
MSC:Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse assesses a client with diabetes mellitus 3 hours after a surgical procedure and notes the clients
breath has a fruity odor. Which action should the nurse take?
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 536
a. Encourage the client to use an incentive
spirometer.
b. Increase the clients intravenous fluid flow rate.
c. Consult the provider to test for ketoacidosis.
d. Perform meticulous pulmonary hygiene care.

ANS: C
The stress of surgery increases the action of counterregulatory hormones and suppresses the action of insulin,
predisposing the client to ketoacidosis and metabolic acidosis. One manifestation of ketoacidosis is a fruity
odor to the breath. Documentation should occur after all assessments have been completed. Using an incentive
spirometer, increasing IV fluids, and performing pulmonary hygiene will not address this clients problem.
DIF:Applying/Application REF: 1310
KEYiabetes mellitus| hyperglycemia| postoperative nursing
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The
clients blood glucose level is 160 mg/dL. Which action should the nurse take?
a. Document the finding in the clients chart.
b. Administer a bolus of regular insulin IV.
c. Call the surgeon to cancel the procedure.
d. Draw blood gases to assess the metabolic
state.

ANS: A
Clients who have type 1 diabetes and are having surgery have been found to have fewer complications, lower
rates of infection, and better wound healing if blood glucose levels are maintained at between 140 and 180
mg/dL throughout the perioperative period. The nurse should document the finding and proceed with other
operative care. The need for a bolus of insulin, canceling the procedure, or drawing arterial blood gases is not
required.
DIF:Applying/Application REF: 1302
KEYiabetes mellitus| preoperative nursing
MSC:Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which
statement should the nurse include in this clients teaching to prevent injury?
a. Examine your feet using a mirror every day.
b. Rotate your insulin injection sites every week.
c. Check your blood glucose level before each meal.
d. Use a bath thermometer to test the water
temperature.

ANS: D
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 537
Clients with diminished sensory perception can easily experience a burn injury when bathwater is too hot.
Instead of checking the temperature of the water by feeling it, they should use a thermometer. Examining the
feet daily does not prevent injury, although daily foot examinations are important to find problems so they can
be addressed. Rotating insulin and checking blood glucose levels will not prevent injury.
DIF:Applying/Application REF: 1307
KEY: Diabetes mellitus| foot care MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

A nurse reviews the medication list of a client with a 20-year history of diabetes mellitus. The client holds
up the bottle of prescribed duloxetine (Cymbalta) and states, My cousin has depression and is taking this drug.
Do you think Im depressed? How should the nurse respond?
a. Many people with long-term diabetes become depressed after a while.
b. Its for peripheral neuropathy. Do you have burning pain in your feet or
hands?
c. This antidepressant also has anti-inflammatory properties for diabetic pain.
d. No. Many medications can be used for several different disorders.

ANS: B
Damage along nerves causes peripheral neuropathy and leads to burning pain along the nerves. Many drugs,
including duloxetine (Cymbalta), can be used to treat peripheral neuropathy. The nurse should assess the client
for this condition and then should provide an explanation of why this drug is being used. This medication,
although it is used for depression, is not being used for that reason in this case. Duloxetine does not have antiinflammatory
properties. Telling the client that many medications are used for different disorders does not
provide the client with enough information to be useful.
DIF:Applying/Application REF: 1308
KEY: Diabetes mellitus| neuropathy MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to
decreased kidney function in this client?
a. Urine specific gravity of 1.033
b. Presence of protein in the urine
c. Elevated capillary blood glucose
level
d. Presence of ketone bodies in the urine

ANS: B
Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Specific
gravity is elevated with dehydration. Elevated capillary blood glucose levels and ketones in the urine are
consistent with diabetes mellitus but are not specific to renal function.
DIF:Applying/Application REF: 1308
KEYiabetes mellitus| renal failure
MSC:Integrated Process: Nursing Process: Analysis

A nurse develops a dietary plan for a client with diabetes mellitus and new-onset microalbuminuria. Which
component of the clients diet should the nurse decrease?
a. Carbohydrates
b. Proteins
c. Fats
d. Total calories

ANS: B
Restriction of dietary protein to 0.8 g/kg of body weight per day is recommended for clients with
microalbuminuria to delay progression to renal failure. The clients diet does not need to be decreased in
carbohydrates, fats, or total calories.
DIF:Remembering/Knowledge REF: 1309
KEYiabetes mellitus| nutritional requirements
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

A nurse assesses a client who has diabetes mellitus and notes the client is awake and alert, but shaky,
diaphoretic, and weak. Five minutes after administering a half-cup of orange juice, the clients clinical
manifestations have not changed. Which action should the nurse take next?
a. Administer another half-cup of orange juice.
b. Administer a half-ampule of dextrose 50%
intravenously.
c. Administer 10 units of regular insulin subcutaneously.
d. Administer 1 mg of glucagon intramuscularly.

ANS: A
This client is experiencing mild hypoglycemia. For mild hypoglycemic manifestations, the nurse should
administer oral glucose in the form of orange juice. If the symptoms do not resolve immediately, the treatment
should be repeated. The client does not need intravenous dextrose, insulin, or glucagon.
DIF:Applying/Application REF: 1310
KEYiabetes mellitus| hypoglycemia
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert
the nurse to intervene immediately?
a. Serum chloride level of 98 mmol/L
b. Serum calcium level of 8.8 mg/dL
c. Serum sodium level of 132 mmol/L
d. Serum potassium level of 2.5
mmol/L

ANS: D
Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the
extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can
also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels
are slightly low, but this would not be related to hyperglycemia and insulin administration.
DIF:Applying/Application REF: 1305
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the
nurse include in this clients teaching?
a. When ill, avoid eating or drinking to reduce vomiting and diarrhea.
b. Monitor your blood glucose levels at least every 4 hours while sick.
c. If vomiting, do not use insulin or take your oral antidiabetic agent.
d. Try to continue your prescribed exercise regimen even if you are
sick.

ANS: B
When ill, the client should monitor his or her blood glucose at least every 4 hours. The client should continue
taking the medication regimen while ill. The client should continue to eat and drink as tolerated but should not
exercise while sick.
DIF:Applying/Application REF: 1315
KEY: Diabetes mellitus| hyperglycemia MSC: Integrated Process: Teaching/Learning
NOT:Client Needs Category: Health Promotion and Maintenance

A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical
manifestation indicates to the nurse that the therapy needs to be adjusted?
a. Serum potassium level has increased.
b. Blood osmolarity has decreased.
c. Glasgow Coma Scale score is unchanged.
d. Urine remains negative for ketone
bodies.

ANS: C
A slow but steady improvement in central nervous system functioning is the best indicator of therapy
effectiveness for HHS. Lack of improvement in the level of consciousness may indicate inadequate rates of
fluid replacement. The Glasgow Coma Scale assesses the clients state of consciousness against criteria of a
scale including best eye, verbal, and motor responses. An increase in serum potassium, decreased blood
osmolality, and urine negative for ketone bodies do not indicate adequacy of treatment.
DIF:Applying/Application REF: 1310
KEYiabetes mellitus| hyperglycemia

A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10
units of NPH insulin at 0700. At which time should the nurse assess the client for potential problems related to
the NPH insulin?
a. 0800
b. 1600
c. 2000
d. 2300

NS: B
Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to
12 hours, and duration of action of 22 hours. Checking the client at 0800 would be too soon. Checking the
client at 2000 and 2300 would be too late. The nurse should check the client at 1600.
DIF:Applying/Application REF: 1294
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which
statement made by the client indicates a need for additional teaching?
a. I need to have an annual appointment even if my glucose levels are in good control.
b. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick.
c. I can still develop complications even though I do not have to take insulin at this time.
d. If I have surgery or get very ill, I may have to receive insulin injections for a short
time.

ANS: B
Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual
changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in
the future.
DIF:Applying/Application REF: 1299
KEYiabetes mellitus| patient education
MSC:Integrated Process: Teaching/Learning
NOT:Client Needs Category: Health Promotion and Maintenance

hen teaching a client recently diagnosed with type 1 diabetes mellitus, the client states, I will never be
able to stick myself with a needle. How should the nurse respond?
a. I can give your injections to you while you are here in the hospital.
b. Everyone gets used to giving themselves injections. It really does not hurt.
c. Your disease will not be managed properly if you refuse to administer the
shots.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 541
d. Tell me what it is about the injections that are concerning you.

ANS: D
Devote as much teaching time as possible to insulin injection and blood glucose monitoring. Clients with
newly diagnosed diabetes are often fearful of giving themselves injections. If the client is worried about giving
the injections, it is best to try to find out what specifically is causing the concern, so it can be addressed.
Giving the injections for the client does not promote self-care ability. Telling the client that others give
themselves injections may cause the client to feel bad. Stating that you dont know another way to manage the
disease is dismissive of the clients concerns.
DIF:Applying/Application REF: 1318
KEYiabetes mellitus| insulin| psychosocial response
MSC:Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity

A nurse assesses a client with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes
a spongy, swelling area at the site the client uses most frequently for insulin injection. Which action should the
nurse take?
a. Apply ice to the site to reduce inflammation.
b. Consult the provider for a new administration route.
c. Assess the client for other signs of cellulitis.
d. Instruct the client to rotate sites for insulin
injection.

ANS: D
The clients tissue has been damaged from continuous use of the same site. The client should be educated to
rotate sites. The damaged tissue is not caused by cellulitis or any type infection, and applying ice may cause
more damage to the tissue. Insulin can only be administered subcutaneously and intravenously. It would not be
appropriate or practical to change the administration route.
DIF:Applying/Application REF: 1319
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV
contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider
and withhold the prescribed dose?
a. Pioglitazone (Actos)
b. Glimepiride (Amaryl)
c. Glipizide (Glucotrol)
d. Metformin
(Glucophage)

ANS: D
Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 542
This combination would place the client at high risk for kidney failure. The nurse should hold the metformin
dose and contact the provider. The other medications are safe to administer after receiving IV contrast.
DIF:Applying/Application REF: 1290
KEYiabetes mellitus| oral antidiabetic medications| medication safety
MSC:Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse assesses the clients
understanding. Which statement made by the client indicates a need for additional teaching?
a. I should increase my intake of vegetables with higher amounts of dietary fiber.
b. My intake of saturated fats should be no more than 10% of my total calorie
intake.
c. I should decrease my intake of protein and eliminate carbohydrates from my diet.
d. My intake of water is not restricted by my treatment plan or medication regimen.

ANS: C
The client should not completely eliminate carbohydrates from the diet, and should reduce protein if
microalbuminuria is present. The client should increase dietary intake of complex carbohydrates, including
vegetables, and decrease intake of fat. Water does not need to be restricted unless kidney failure is present.
DIF:Applying/Application REF: 1302
KEYiabetes mellitus| nutritional requirements
MSC:Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin
regimen:
Fasting blood glucose: 75 mg/dL
Postprandial blood glucose: 200 mg/dL
Hemoglobin A1c level: 5.5%
How should the nurse interpret these laboratory findings?
a. Increased risk for developing ketoacidosis
b. Good control of blood glucose
c. Increased risk for developing
hyperglycemia
d. Signs of insulin resistance

ANS: B
The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen.
Because the clients glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia
and is not showing signs of insulin resistance.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 543
DIF:Applying/Application REF: 1294
KEYiabetes mellitus| laboratory values
MSC:Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse prepares to administer insulin to a client at 1800. The clients medication administration record
contains the following information:
Insulin glargine: 12 units daily at 1800
Regular insulin: 6 units QID at 0600, 1200, 1800, 2400
Based on the clients medication administration record, which action should the nurse take?
a. Draw up and inject the insulin glargine first, and then draw up and inject the regular insulin.
b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and inject the regular
insulin.
c. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in the same syringe, mix,
and inject the two insulins together.
d. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in the same syringe, mix,
and inject the two insulins together.

ANS: A
Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing results in an
unpredictable alteration in the onset of action and time to peak action. The correct instruction is to draw up and
inject first the glargine and then the regular insulin right afterward.
DIF:Applying/Application REF: 1294
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse prepares to administer prescribed regular and NPH insulin. Place the nurses actions in the correct
order to administer these medications.
1. Inspect bottles for expiration dates.
2. Gently roll the bottle of NPH between the hands.
3. Wash your hands.
4. Inject air into the regular insulin.
5. Withdraw the NPH insulin.
6. Withdraw the regular insulin.
7. Inject air into the NPH bottle.
8. Clean rubber stoppers with an alcohol swab.
a. 1, 3, 8, 2, 4, 6, 7, 5
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 544
b. 3, 1, 2, 8, 7, 4, 6, 5
c. 8, 1, 3, 2, 4, 6, 7, 5
d. 2, 3, 1, 8, 7, 5, 4, 6

ANS: B
After washing hands, it is important to inspect the bottles and then to roll the NPH to mix the insulin. Rubber
stoppers should be cleaned with alcohol after rolling the NPH and before sticking a needle into either bottle. It
is important to inject air into the NPH bottle before placing the needle in a regular insulin bottle to avoid
mixing of regular and NPH insulin. The shorter-acting insulin is always drawn up first.
DIF:Applying/Application REF: 1296
KEYiabetes mellitus| insulin| medication safety
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

44.A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis:
Vital Signs and Assessment Laboratory
Results
Medications
Blood pressure: 90/62 mm Hg
Pulse: 120 beats/min
Respiratory rate: 28 breaths/min
Urine output: 20 mL/hr via
catheter
Serum potassium: 2.6
mEq/L
Potassium chloride 40 mEq IV bolus
STAT
Increase IV fluid to 100 mL/hr
Which action should the nurse take?
a. Administer the potassium and then consult with the provider about the fluid order.
b. Increase the intravenous rate and then consult with the provider about the potassium
prescription.
c. Administer the potassium first before increasing the infusion flow rate.
d. Increase the intravenous flow rate before administering the potassium.

ANS: B
The client is acutely ill and is severely dehydrated and hypokalemic. The client requires more IV fluids and
potassium. However, potassium should not be infused unless the urine output is at least 30 mL/hr. The nurse
should first increase the IV rate and then consult with the provider about the potassium.
DIF:Applying/Application REF: 1313
KEYiabetes mellitus| medication safety| electrolyte imbalance
MSC:Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

At 4:45 p.m., a nurse assesses a client with diabetes mellitus who is recovering from an abdominal
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 545
hysterectomy 2 days ago. The nurse notes that the client is confused and diaphoretic. The nurse reviews the
assessment data provided in the chart below:
Capillary Blood Glucose Testing
(AC/HS)
Dietary
Intake
At 0630: 95
At 1130: 70
At 1630: 47
Breakfast: 10% eaten client states she is not
hungry
Lunch: 5% eaten client is nauseous; vomits once
After reviewing the clients assessment data, which action is appropriate at this time?
a. Assess the clients oxygen saturation level and administer oxygen.
b. Reorient the client and apply a cool washcloth to the clients
forehead.
c. Administer dextrose 50% intravenously and reassess

d. Provide a glass of orange juice and encourage the client to eat dinner

ANS: C
The clients symptoms are related to hypoglycemia. Since the client has not been tolerating food, the nurse
should administer dextrose intravenously. The clients oxygen level could be checked, but based on the
information provided, this is not the priority. The client will not be reoriented until the glucose level rises.
DIF:Applying/Application REF: 1314
KEYiabetes mellitus| hypoglycemia
MSC:Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse assesses clients at a health fair. Which clients should the nurse counsel to be tested for diabetes?
(Select all that apply.)
a. 56-year-old African-American male
b. Female with a 30-pound weight gain during pregnancy
c. Male with a history of pancreatic trauma
d. 48-year-old woman with a sedentary lifestyle
e. Male with a body mass index greater than 25 kg/m2
f. 28-year-old female who gave birth to a baby weighing 9.2
pounds

ANS: A, D, E, F
Risk factors for type 2 diabetes include certain ethnic/racial groups (African Americans, American Indians,
Hispanics), obesity and physical inactivity, and giving birth to large babies. Pancreatic trauma and a 30-pound
gestational weight gain are not risk factors.
DIF:Applying/Application REF: 1287

A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should
the nurse monitor the client? (Select all that apply.)
a. Deep and fast respirations
b. Decreased urine output
c. Tachycardia
d. Dependent pulmonary
crackles
e. Orthostatic hypotension

ANS: A, C, E
DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients
have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of
diuresis and dehydration, peripheral edema and crackles do not occur.
DIF:Applying/Application REF: 1313
KEYiabetes mellitus| hyperglycemia
MSC:Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse teaches a client with diabetes mellitus about foot care. Which statements should the nurse include in
this clients teaching? (Select all that apply.)
a. Do not walk around barefoot.
b. Soak your feet in a tub each evening.
c. Trim toenails straight across with a nail
clipper.
d. Treat any blisters or sores with Epsom salts.
e. Wash your feet every other day.

ANS: A, C
Clients who have diabetes mellitus are at high risk for wounds on the feet secondary to peripheral neuropathy
and poor arterial circulation. The client should be instructed to not walk around barefoot or wear sandals with
open toes. These actions place the client at higher risk for skin breakdown of the feet. The client should be
instructed to trim toenails straight across with a nail clipper. Feet should be washed daily with lukewarm water
and soap, but feet should not be soaked in the tub. The client should contact the provider immediately if
blisters or sores appear and should not use home remedies to treat these wounds.
DIF:Understanding/Comprehension REF: 1307
KEY: Diabetes mellitus| foot care MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

nurse provides diabetic education at a public health fair. Which disorders should the nurse include as
complications of diabetes mellitus? (Select all that apply.)
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 547
a. Stroke
b. Kidney failure
c. Blindness
d. Respiratory
failure
e. Cirrhosis

ANS: A, B, C
Complications of diabetes mellitus are caused by macrovascular and microvascular changes. Macrovascular
complications include coronary artery disease, cerebrovascular disease, and peripheral vascular disease.
Microvascular complications include nephropathy, retinopathy, and neuropathy. Respiratory failure and
cirrhosis are not complications of diabetes mellitus.
DIF:Understanding/Comprehension REF: 1283
KEY: Diabetes mellitus| health screening MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse collaborates with the interdisciplinary team to develop a plan of care for a client who is newly
diagnosed with diabetes mellitus. Which team members should the nurse include in this interdisciplinary team
meeting? (Select all that apply.)
a. Registered dietitian
b. Clinical pharmacist
c. Occupational therapist
d. Health care provider
e. Speech-language pathologist

ANS: A, B, D
When planning care for a client newly diagnosed with diabetes mellitus, the nurse should collaborate with a
registered dietitian, clinical pharmacist, and health care provider. The focus of treatment for a newly diagnosed
client would be nutrition, medication therapy, and education. The nurse could also consult with a diabetic
educator. There is no need for occupational therapy or speech therapy at this time.
DIF:Applying/Application REF: 1307
KEYiabetes mellitus| collaboration
MSC:Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care