NURS H 356Extra Questions
DIABETES MELLITUS QUESTIONS
1. Which of the following persons would most likely be diagnosed with diabetes mellitus? A
44- year-old:
a. Caucasian woman.
b. Asian woman.
c. African-American woman.
d. Hispanic male.
Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and
Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
2. Which of the following factors are risks for the development of diabetes mellitus? (Select all
that apply.)
a. Age over 45 years
b. Overweight with a waist/hip ratio >1
c. Having a consistent HDL level above 40 mg/dl
d. Maintaining a sedentary lifestyle
Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight
with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in
atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.
3. Which laboratory test should a nurse anticipate a physician would order when an older person
is identified as high-risk for diabetes mellitus? (Select all that apply.)
a. Fasting Plasma Glucose (FPG)
b. Two-hour Oral Glucose Tolerance Test (OGTT)
c. Glycosylated hemoglobin (HbA1C)
d. Finger stick glucose three times daily
Rationale: When an older person is identified as high-risk for diabetes, appropriate testing would
include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to
determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-
term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.
4. Of which of the following symptoms might an older woman with diabetes mellitus complain?
a. Anorexia
b. Pain intolerance
c. Weight loss
d. Perineal itching
,NURS H 356Extra Questions
Rationale: Older women might complain of perineal itching due to vaginal candidiasis.
5. When an older adult is admitted to the hospital with a diagnosis of diabetes mellitus and
complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the
gerontology nurse should anticipate which of the following secondary medical
diagnoses?
a. Impaired glucose tolerance
b. Gestational diabetes mellitus
c. Pituitary tumor
d. Pancreatic tumor
Rationale: The onset of hyperglycemia in the older adult can occur more slowly. When the older adult
reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider
should consider pancreatic tumor.
6. The principal goals of therapy for older patients who have poor glycemic control are:
a. Enhancing quality of life.
b. Decreasing the chance of complications.
c. Improving self-care through education.
d. All of the above.
Rationale: The principal goals of therapy for older persons with diabetes mellitus and poor glycemic
control are enhancing quality of life, decreasing the chance of complications, improving self-care
through education, and maintaining or improving general health status.
7. Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus?
a. Physical exercise can slow the progression of diabetes mellitus.
b. Strenuous exercise is beneficial when the blood glucose is high.
c. Patients who take insulin and engage in strenuous physical exercise might
experience hyperglycemia.
d. Adjusting insulin regimen allows for safe participation in all forms of exercise.
Rationale: Physical exercise slows the progression of diabetes mellitus, because exercise has beneficial
effects on carbohydrate metabolism and insulin sensitivity. Strenuous exercise can cause hypoglycemia.
Insulin and foods both must be adjusted to allow safe participation in exercise.
8. A diabetic patient experiencing a reaction of alternating periods of nocturnal hypoglycemia
and hyperglycemia might be manifesting which of the following?
,NURS H 356Extra Questions
a. Uncontrolled diabetes
b. Somogyi phenomenon
c. Brittle diabetes
d. Diabetes insipidus
Rationale: Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked
increase in glucose and increase in ketones.
9. The primary purpose for sulfonylureas, such as long-acting glyburide (Micronase), is to:
a. Induce hypoglycemia by decreasing insulin sensitivity.
b. Improve insulin sensitivity and decrease hyperglycemia.
c. Stimulate the beta cells of the pancreas to secrete insulin.
d. Decrease insulin sensitivity by enhancing glucose uptake.
Rationale: Sulfonylureas such as glyburide are used only with patients who have some remaining
pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose
output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor
sites for interaction with insulin.
10. One of the benefits of Glargine (Lantus) insulin is its ability to:
a. Release insulin rapidly throughout the day to help control basal glucose.
b. Release insulin evenly throughout the day and control basal glucose levels.
c. Simplify the dosing and better control blood glucose levels during the day.
d. Cause hypoglycemia with other manifestation of other adverse reactions.
Rationale: Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control
basal glucose levels.
11. A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with
pneumonia. The client's intake has been very poor, and she is admitted to the hospital for
observation and management as needed. What is the most likely problem with this patient?
a. Insulin resistance has developed.
b. Diabetic ketoacidosis is occurring.
c. Hypoglycemia unawareness is developing.
d. Hyperglycemic hyperosmolar non-ketotic coma
Rationale: Illness, especially with the frail elderly patient whose appetite is poor, can result in
dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units
, NURS H 356Extra Questions
or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly
decreased amounts of insulin.
12. A client is at the physician’s office for an annual physical examination. The client is a 48 year
old client, who is overweight, B/P 142/92, and fasting blood glucose is 112. The nurse will plan
interventions based on the medical diagnosis of:
a. Impaired glucose
tolerance. b. Prediabetes.
c. Type 2 diabetes.
d. Type 1 diabetes.
In prediabetes, there is either impaired fasting blood glucose (diagnostic level 100 to 125 mg/dl.) or an
impaired glucose tolerance which involves checking the two hour postmeal blood glucose (diagnostic
level is 140-199 mg/dl). In this example the client did not have his glucose tolerance checked but he does
have an elevated fasting glucose. In both Type 1 and Type 2 diabetes, there must be two fasting
glucoses on subsequent days of 126 mg/dl or greater. Typically, in prediabetes, the client also has other
characteristic symptoms of Type 2 diabetes as does this client of obesity, age over 40, and elevated
blood pressure.
13. A client with Type 2 diabetes is coming into the clinic for his routine diabetes evaluation. The
client states the last hemoglobin A1C six months ago was 6.5%. In order to assess the
client’s understanding of the meaning of the lab work, the nurse would ask the client to:
a. Explain how the A1C relates to his diabetes.
b. State his A1C goal and what actions help to meet the goal.
c. Discuss the frequency of testing as recommended by the American Diabetes Association.
d. Review problems that can cause the A1C to be inaccurate.
The American Diabetes Association recommends that A1C be the primary target for glycemic control
with individualized goals. In most populations that goal should be < 7.0 % .The American College of
Endocrinologists recommend a level below 6.5%. While it is necessary that the client understand other
aspects of the A1C, knowing his goal and how to achieve it will best aid the nurse in evaluating whether
the client understands the meaning of the test.
14. The client has a 6:30 AM blood glucose of 273; there are a small amount of urinary
ketones present. The insulin regimen is ordered as follows:
70/30 Insulin- AM- 25 Units
70/30 Insulin- PM- 18 Units
Sliding Scale- BG 175- 200- 4 Units regular Insulin
Sliding Scale- BG 201- 250- 5 Units regular Insulin
DIABETES MELLITUS QUESTIONS
1. Which of the following persons would most likely be diagnosed with diabetes mellitus? A
44- year-old:
a. Caucasian woman.
b. Asian woman.
c. African-American woman.
d. Hispanic male.
Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and
Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
2. Which of the following factors are risks for the development of diabetes mellitus? (Select all
that apply.)
a. Age over 45 years
b. Overweight with a waist/hip ratio >1
c. Having a consistent HDL level above 40 mg/dl
d. Maintaining a sedentary lifestyle
Rationale: Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight
with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in
atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.
3. Which laboratory test should a nurse anticipate a physician would order when an older person
is identified as high-risk for diabetes mellitus? (Select all that apply.)
a. Fasting Plasma Glucose (FPG)
b. Two-hour Oral Glucose Tolerance Test (OGTT)
c. Glycosylated hemoglobin (HbA1C)
d. Finger stick glucose three times daily
Rationale: When an older person is identified as high-risk for diabetes, appropriate testing would
include FPG and OGTT. A FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to
determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-
term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.
4. Of which of the following symptoms might an older woman with diabetes mellitus complain?
a. Anorexia
b. Pain intolerance
c. Weight loss
d. Perineal itching
,NURS H 356Extra Questions
Rationale: Older women might complain of perineal itching due to vaginal candidiasis.
5. When an older adult is admitted to the hospital with a diagnosis of diabetes mellitus and
complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the
gerontology nurse should anticipate which of the following secondary medical
diagnoses?
a. Impaired glucose tolerance
b. Gestational diabetes mellitus
c. Pituitary tumor
d. Pancreatic tumor
Rationale: The onset of hyperglycemia in the older adult can occur more slowly. When the older adult
reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider
should consider pancreatic tumor.
6. The principal goals of therapy for older patients who have poor glycemic control are:
a. Enhancing quality of life.
b. Decreasing the chance of complications.
c. Improving self-care through education.
d. All of the above.
Rationale: The principal goals of therapy for older persons with diabetes mellitus and poor glycemic
control are enhancing quality of life, decreasing the chance of complications, improving self-care
through education, and maintaining or improving general health status.
7. Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus?
a. Physical exercise can slow the progression of diabetes mellitus.
b. Strenuous exercise is beneficial when the blood glucose is high.
c. Patients who take insulin and engage in strenuous physical exercise might
experience hyperglycemia.
d. Adjusting insulin regimen allows for safe participation in all forms of exercise.
Rationale: Physical exercise slows the progression of diabetes mellitus, because exercise has beneficial
effects on carbohydrate metabolism and insulin sensitivity. Strenuous exercise can cause hypoglycemia.
Insulin and foods both must be adjusted to allow safe participation in exercise.
8. A diabetic patient experiencing a reaction of alternating periods of nocturnal hypoglycemia
and hyperglycemia might be manifesting which of the following?
,NURS H 356Extra Questions
a. Uncontrolled diabetes
b. Somogyi phenomenon
c. Brittle diabetes
d. Diabetes insipidus
Rationale: Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked
increase in glucose and increase in ketones.
9. The primary purpose for sulfonylureas, such as long-acting glyburide (Micronase), is to:
a. Induce hypoglycemia by decreasing insulin sensitivity.
b. Improve insulin sensitivity and decrease hyperglycemia.
c. Stimulate the beta cells of the pancreas to secrete insulin.
d. Decrease insulin sensitivity by enhancing glucose uptake.
Rationale: Sulfonylureas such as glyburide are used only with patients who have some remaining
pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose
output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor
sites for interaction with insulin.
10. One of the benefits of Glargine (Lantus) insulin is its ability to:
a. Release insulin rapidly throughout the day to help control basal glucose.
b. Release insulin evenly throughout the day and control basal glucose levels.
c. Simplify the dosing and better control blood glucose levels during the day.
d. Cause hypoglycemia with other manifestation of other adverse reactions.
Rationale: Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control
basal glucose levels.
11. A frail elderly patient with a diagnosis of type 2 diabetes mellitus has been ill with
pneumonia. The client's intake has been very poor, and she is admitted to the hospital for
observation and management as needed. What is the most likely problem with this patient?
a. Insulin resistance has developed.
b. Diabetic ketoacidosis is occurring.
c. Hypoglycemia unawareness is developing.
d. Hyperglycemic hyperosmolar non-ketotic coma
Rationale: Illness, especially with the frail elderly patient whose appetite is poor, can result in
dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units
, NURS H 356Extra Questions
or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly
decreased amounts of insulin.
12. A client is at the physician’s office for an annual physical examination. The client is a 48 year
old client, who is overweight, B/P 142/92, and fasting blood glucose is 112. The nurse will plan
interventions based on the medical diagnosis of:
a. Impaired glucose
tolerance. b. Prediabetes.
c. Type 2 diabetes.
d. Type 1 diabetes.
In prediabetes, there is either impaired fasting blood glucose (diagnostic level 100 to 125 mg/dl.) or an
impaired glucose tolerance which involves checking the two hour postmeal blood glucose (diagnostic
level is 140-199 mg/dl). In this example the client did not have his glucose tolerance checked but he does
have an elevated fasting glucose. In both Type 1 and Type 2 diabetes, there must be two fasting
glucoses on subsequent days of 126 mg/dl or greater. Typically, in prediabetes, the client also has other
characteristic symptoms of Type 2 diabetes as does this client of obesity, age over 40, and elevated
blood pressure.
13. A client with Type 2 diabetes is coming into the clinic for his routine diabetes evaluation. The
client states the last hemoglobin A1C six months ago was 6.5%. In order to assess the
client’s understanding of the meaning of the lab work, the nurse would ask the client to:
a. Explain how the A1C relates to his diabetes.
b. State his A1C goal and what actions help to meet the goal.
c. Discuss the frequency of testing as recommended by the American Diabetes Association.
d. Review problems that can cause the A1C to be inaccurate.
The American Diabetes Association recommends that A1C be the primary target for glycemic control
with individualized goals. In most populations that goal should be < 7.0 % .The American College of
Endocrinologists recommend a level below 6.5%. While it is necessary that the client understand other
aspects of the A1C, knowing his goal and how to achieve it will best aid the nurse in evaluating whether
the client understands the meaning of the test.
14. The client has a 6:30 AM blood glucose of 273; there are a small amount of urinary
ketones present. The insulin regimen is ordered as follows:
70/30 Insulin- AM- 25 Units
70/30 Insulin- PM- 18 Units
Sliding Scale- BG 175- 200- 4 Units regular Insulin
Sliding Scale- BG 201- 250- 5 Units regular Insulin
