LATEST 2024 Diabetes Mellitus NCLEX Style Questions

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? a. A 48-year-old woman with a hemoglobin A1C of 8.4% b. A 58-year-old man with a fasting blood glucose of 111 mg/dL c. A 68-year-old woman with a random plasma glucose of 190 mg/dL d. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL - CORRECT ANSWER a. A 48-year-old woman with a hemoglobin A1C of 8.4% Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL. The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? a. "I will discard any insulin bottle that is cloudy in appearance." b. "The best injection site for insulin administration is in my abdomen." c. "I can wash the site with soap and water before insulin administration." d. "I may keep my insulin at room temperature (75o F) for up to a month." - CORRECT ANSWER a. "I will discard any insulin bottle that is cloudy in appearance." Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (less than 32° F [0° C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen. The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? a. "I plan to lose 25 pounds this year by following a high-protein diet." b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." c. "I should include more fiber in my diet than a person who does not have diabetes." d. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet." - CORRECT ANSWER b. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes mellitus. High-protein diets are not recommended for weight loss. Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? a. A 58-year-old patient with diabetic retinopathy b. A 73-year-old patient who takes propranolol (Inderal) c. A 19-year-old patient who is on the school track team d. A 24-year-old patient with a hemoglobin A1C of 8.9% - CORRECT ANSWER b. A 73- year-old patient who takes propranolol (Inderal) Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness. The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? a. "Smokeless tobacco products decrease the risk of kidney damage." b. "I can help control my blood pressure by avoiding foods high in salt." c. "I should have yearly dilated eye examinations by an ophthalmologist." d. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL." - CORRECT ANSWER b. "I can help control my blood pressure by avoiding foods high in salt." Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed. A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? a. "With type 2 diabetes, the body of the pancreas becomes inflamed." b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." c. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas." - CORRECT ANSWER b. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced, and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus. The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? a. Prealbumin level b. Urine ketone level c. Fasting glucose level d. Glycosylated hemoglobin level - CORRECT ANSWER d. Glycosylated hemoglobin level A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control. The nurse has been teaching a patient with diabetes mellitus how to perform self- monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what?