Diabetes NCLEX questions
A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type 2""
means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs
from type 1 diabetes primarily in that with type 2 diabetes
a. the pt is totally dependent on an outside source of insulin
b. there is a decreased insulin secretion and cellular resistance to insulin that is produced
c. the immune system destroys the pancreatic insulin-producing cells
d. the insulin precurosr that is secreted by the pancreas is not activated by the liver - correct
answer-Answer B - there is a decreased insulin secretion and cellular resistance to insulin
that is produced
Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for
the body's needs or the cells do not respond to the insulin appropriately. The other
information describes the physiology of type 1 diabetes
The benefits of using an insulin pump include all of the following except:
a. By continuously providing insulin they eliminate the need for injections of insulin
b. They simplify management of blood sugar and often improve A1C
c. They enable exercise without compensatory carbohydrate consumption
d. They help with weight loss - correct answer-Answer d. They help with weight loss
Rationale" Using an insulin pump has many advantages, including fewer dramatic swings in
blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses
and delivery; however, the use of an insulin pump has been associated with weight gain.
A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means.
Which of the following is the most appropriate response by the nurse?
1. "With type 2 diabetes, the body of the pancreas becomes inflamed."
2. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased."
3. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin."
4. "With type 2 diabetes, the body produces auto-antibodies that destroy b-cells in the
pancreas."" - correct answer-Answer: 2
Rationale: 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"
A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which
findings is the nurse most likely to observe in this client? Select all that apply:
"1. Excessive thirst
2. Weight gain
,3. Constipation
4. Excessive hunger
5. Urine retention
6. Frequent, high-volume urination - correct answer-1, 4, 6 - Excessive thirst, excessive
hunger, frequent. high-volume urination
Rationale: Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia
(excessive hunger), and polyuria (excessive urination). Because the body is starving from
the lack of glucose the cells are using for energy, the client has weight loss, not weight gain.
Clients with diabetes mellitus usually don't present with constipation. Urine retention is only a
problem is the patient has another renal-related condition.
A client is brought to the emergency department in an unresponsive state, and a diagnosis
of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately
prepare to initiate which of the following anticipated physician's prescriptions?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate - correct answer-ANSWER: 3. Intravenous
infusion of normal saline
Rationale: The primary goal of treatment is hyperglycemic hyperosmolar nonketotic
syndrome (HHNS) is to rehydrate the client to restore the fluid volume and to correct
electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic
keto acidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH
insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided
because it can precipitate a further drop in serum potassium levels. Intubation and
mechanical ventilation are not required to treat HHNS.
A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that
the mostlikely time for a hypoglycemic reaction to occur is:
A) 2-4 hours after administration
B) 4-12 hours after administration
C) 16-18 hours after administration
D) 18-24 hours after administration - correct answer-B: 4-12 hours
Rationale: Humulin is an intermediate acting insulin. The onset of action is 1.5 hours, it
peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to insulin are most
likely to occur during the peak time.
A client who is started on metformin and glyburide would have initially presented with which
symptoms?
a. Polydispisa, polyuria, and weight loss
b. weight gain, tiredness, & bradycardia
c. irritability, diaphoresis, and tachycardia
, d. diarrhea, abdominal pain, and weight loss - correct answer-ANSWER: a. Polydispisa,
polyuria, and weight loss.
Rationale: Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss.
Metformin and sulfonylureas are commonly ordered medications.
Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism.
Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia.
Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss."
A client with diabetes mellitus demonstratees acute anxiety when first admitted for the
treatment of hyperglycemia. The most appropriate intervention to decrease the client's
anxiety would be to
1. administer a sedative
2. make sure the client knows all the correct medical terms to understand what is happening
3. ignore the signs and symptoms of anxiety so that they will soon disappear
4. convey empathy, trust, and respect toward the client - correct answer-4. convey empathy,
trust, and respect toward the client
Rationale: The most appropriate intervention is to address the client's feelings related to the
anxiety
A client with diabetes melllitus has a blood glucose of 644mg/dl. The nurse intreprets that
this client is most at risk of developing which type of acid base imbalance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis" - correct answer-Answer: A, Metabolic Acidosis
Rationale: DM can lead to metabolic acidosis. When the body does not have sufficient
circulating insulin, the blood glucose level rises. At the same time, the cells of the body use
all available glucose. The body then breaks down glycogen and fat for fuel. The by-products
of fat metabolism are acidotic and can lead to the condition known as diabetic ketoacidosis."
A client with DKA is being treated in the ED. What would the nurse suspect?
1. Comatose state
2. Decreased Urine Output
3. Increased respirations and an increase in pH.
4. Elevated blood glucose level and low plasma bicarbonate level. - correct answer-Answer:
4 Elevated blood glucose level and low plasma bicarbonate level.
Rationale: In DKA the arteriole pH is lower than 7.35, plasma bicarbonate is lower than 15
mEq/L, the blood glucose is higher than 250, and ketones are present in the blood and urine.
A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type 2""
means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs
from type 1 diabetes primarily in that with type 2 diabetes
a. the pt is totally dependent on an outside source of insulin
b. there is a decreased insulin secretion and cellular resistance to insulin that is produced
c. the immune system destroys the pancreatic insulin-producing cells
d. the insulin precurosr that is secreted by the pancreas is not activated by the liver - correct
answer-Answer B - there is a decreased insulin secretion and cellular resistance to insulin
that is produced
Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for
the body's needs or the cells do not respond to the insulin appropriately. The other
information describes the physiology of type 1 diabetes
The benefits of using an insulin pump include all of the following except:
a. By continuously providing insulin they eliminate the need for injections of insulin
b. They simplify management of blood sugar and often improve A1C
c. They enable exercise without compensatory carbohydrate consumption
d. They help with weight loss - correct answer-Answer d. They help with weight loss
Rationale" Using an insulin pump has many advantages, including fewer dramatic swings in
blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses
and delivery; however, the use of an insulin pump has been associated with weight gain.
A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means.
Which of the following is the most appropriate response by the nurse?
1. "With type 2 diabetes, the body of the pancreas becomes inflamed."
2. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased."
3. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin."
4. "With type 2 diabetes, the body produces auto-antibodies that destroy b-cells in the
pancreas."" - correct answer-Answer: 2
Rationale: 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"
A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which
findings is the nurse most likely to observe in this client? Select all that apply:
"1. Excessive thirst
2. Weight gain
,3. Constipation
4. Excessive hunger
5. Urine retention
6. Frequent, high-volume urination - correct answer-1, 4, 6 - Excessive thirst, excessive
hunger, frequent. high-volume urination
Rationale: Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia
(excessive hunger), and polyuria (excessive urination). Because the body is starving from
the lack of glucose the cells are using for energy, the client has weight loss, not weight gain.
Clients with diabetes mellitus usually don't present with constipation. Urine retention is only a
problem is the patient has another renal-related condition.
A client is brought to the emergency department in an unresponsive state, and a diagnosis
of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately
prepare to initiate which of the following anticipated physician's prescriptions?
1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate - correct answer-ANSWER: 3. Intravenous
infusion of normal saline
Rationale: The primary goal of treatment is hyperglycemic hyperosmolar nonketotic
syndrome (HHNS) is to rehydrate the client to restore the fluid volume and to correct
electrolyte deficiency. Intravenous fluid replacement is similar to that administered in diabetic
keto acidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH
insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided
because it can precipitate a further drop in serum potassium levels. Intubation and
mechanical ventilation are not required to treat HHNS.
A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that
the mostlikely time for a hypoglycemic reaction to occur is:
A) 2-4 hours after administration
B) 4-12 hours after administration
C) 16-18 hours after administration
D) 18-24 hours after administration - correct answer-B: 4-12 hours
Rationale: Humulin is an intermediate acting insulin. The onset of action is 1.5 hours, it
peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to insulin are most
likely to occur during the peak time.
A client who is started on metformin and glyburide would have initially presented with which
symptoms?
a. Polydispisa, polyuria, and weight loss
b. weight gain, tiredness, & bradycardia
c. irritability, diaphoresis, and tachycardia
, d. diarrhea, abdominal pain, and weight loss - correct answer-ANSWER: a. Polydispisa,
polyuria, and weight loss.
Rationale: Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss.
Metformin and sulfonylureas are commonly ordered medications.
Weight gain, tiredness, and bradycardia are symptoms of hypothyroidism.
Irritability, diaphoresis, and tachycardia are symptoms of hypoglycemia.
Symptoms of Crohn's disease include diarrhea, abdominal pain, and weight loss."
A client with diabetes mellitus demonstratees acute anxiety when first admitted for the
treatment of hyperglycemia. The most appropriate intervention to decrease the client's
anxiety would be to
1. administer a sedative
2. make sure the client knows all the correct medical terms to understand what is happening
3. ignore the signs and symptoms of anxiety so that they will soon disappear
4. convey empathy, trust, and respect toward the client - correct answer-4. convey empathy,
trust, and respect toward the client
Rationale: The most appropriate intervention is to address the client's feelings related to the
anxiety
A client with diabetes melllitus has a blood glucose of 644mg/dl. The nurse intreprets that
this client is most at risk of developing which type of acid base imbalance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis" - correct answer-Answer: A, Metabolic Acidosis
Rationale: DM can lead to metabolic acidosis. When the body does not have sufficient
circulating insulin, the blood glucose level rises. At the same time, the cells of the body use
all available glucose. The body then breaks down glycogen and fat for fuel. The by-products
of fat metabolism are acidotic and can lead to the condition known as diabetic ketoacidosis."
A client with DKA is being treated in the ED. What would the nurse suspect?
1. Comatose state
2. Decreased Urine Output
3. Increased respirations and an increase in pH.
4. Elevated blood glucose level and low plasma bicarbonate level. - correct answer-Answer:
4 Elevated blood glucose level and low plasma bicarbonate level.
Rationale: In DKA the arteriole pH is lower than 7.35, plasma bicarbonate is lower than 15
mEq/L, the blood glucose is higher than 250, and ketones are present in the blood and urine.
