Chapter 64: Care of Patients with Diabetes
Mellitus
Chapter 64: Care of Patients with Diabetes Mellitus
Ignatavicius: MedicalSurgical Nursing, 8th Edition
MULTIPLE CHOICE
1.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 body’s 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.
2.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 client’s 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 client’s serum osmolarity is high. The client’s sodium would be
expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not
related to the polyuria.
3.After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus,
the nurse assesses the client’s 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 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.
4.A nurse assesses a client who has a 15year history of diabetes and notes decreased
tactile sensation in both feet. Which action should the nurse take first?
a. Document the finding in the client’s chart.
b. Assess tactile sensation in the client’s hands.
c. Examine the client’s 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 client’s 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.
5.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 HLADR 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.
6.A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should
the nurse include in this client’s 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 longterm 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.
7.A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest
risk?
a. A 29yearold Caucasian
b. A 32yearold AfricanAmerican
c. A 44yearold Asian
d. A 48yearold 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 middleaged places this client at highest risk.
8.A nurse teaches a client about selfmonitoring of blood glucose levels. Which statement
should the nurse include in this client’s 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.”
Mellitus
Chapter 64: Care of Patients with Diabetes Mellitus
Ignatavicius: MedicalSurgical Nursing, 8th Edition
MULTIPLE CHOICE
1.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 body’s 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.
2.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 client’s 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 client’s serum osmolarity is high. The client’s sodium would be
expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not
related to the polyuria.
3.After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus,
the nurse assesses the client’s 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 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.
4.A nurse assesses a client who has a 15year history of diabetes and notes decreased
tactile sensation in both feet. Which action should the nurse take first?
a. Document the finding in the client’s chart.
b. Assess tactile sensation in the client’s hands.
c. Examine the client’s 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 client’s 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.
5.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 HLADR 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.
6.A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should
the nurse include in this client’s 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 longterm 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.
7.A nurse assesses clients who are at risk for diabetes mellitus. Which client is at greatest
risk?
a. A 29yearold Caucasian
b. A 32yearold AfricanAmerican
c. A 44yearold Asian
d. A 48yearold 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 middleaged places this client at highest risk.
8.A nurse teaches a client about selfmonitoring of blood glucose levels. Which statement
should the nurse include in this client’s 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.”
