Chapter 59: Concepts of Care for Patients
with Diabetes Mellitus
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse develops a dietary plan for a client with diabetes mellitus and new-onset
microalbuminuria. Which component of the client’s diet would the nurse decrease?
a. Carbohydrates
b. Proteins
c. Fats
d. Total calories
ANS: B
Restriction of dietary protein is recommended for clients with microalbuminuria to
delay progression to renal failure. The client’s diet does not need to be decreased in
carbohydrates, fats, or total calories.
DIF: Remembering TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Complications MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
2. A nurse assesses a client who has diabetes mellitus and notes that the client is awake
and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-
cup (120 mL) of orange juice, the client’s signs and symptoms have not changed.
What action would the nurse take next?
a. Administer another half-cup (120 mL) 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 patient is experiencing mild hypoglycemia. For mild hypoglycemic
manifestations, the nurse would administer oral glucose in the form of orange juice. If
the symptoms do not resolve immediately, the treatment would be repeated. The
patient does not need intravenous dextrose, insulin, or glucagon.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Diabetes mellitus, Complications MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
3. A nurse reviews the laboratory results of a client who is receiving intravenous insulin.
Which would alert the nurse to intervene immediately?
a. Serum chloride level of 98 mEq/L (98 mmol/L)
b. Serum calcium level of 8.8 mg/dL (2.2 mmol/L)
c. Serum sodium level of 132 mEq (132 mmol/L)
d. Serum potassium level of 2.5 mEq/L (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 TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Diabetes mellitus, Drug therapy MSC:
Client Needs Category: Physiological Integrity: Reduction of Risk Potential
, 4. A nurse teaches a client with diabetes mellitus about sick-day management. Which
statement would the nurse include in this client’s 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: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Complications MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
5. The nurse is caring for a client who has diabetes mellitus. The nurse administers 6
units of regular insulin and 10 units of NPH insulin at 7:00 a.m. (0700). At which time
would the nurse assess the client for potential hypoglycemia related to the NPH
insulin?
a. 8:00 a.m. (0800)
b. 4:00 p.m. (1600)
c. 8:00 p.m. (2000)
d. 11:00 p.m. (2300)
ANS: 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 patient at 2000 and 2300 would be too
late. The nurse would check the patient at 1600 (4:00 p.m.).
with Diabetes Mellitus
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse develops a dietary plan for a client with diabetes mellitus and new-onset
microalbuminuria. Which component of the client’s diet would the nurse decrease?
a. Carbohydrates
b. Proteins
c. Fats
d. Total calories
ANS: B
Restriction of dietary protein is recommended for clients with microalbuminuria to
delay progression to renal failure. The client’s diet does not need to be decreased in
carbohydrates, fats, or total calories.
DIF: Remembering TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Complications MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
2. A nurse assesses a client who has diabetes mellitus and notes that the client is awake
and alert, but shaky, diaphoretic, and weak. Five minutes after administering a half-
cup (120 mL) of orange juice, the client’s signs and symptoms have not changed.
What action would the nurse take next?
a. Administer another half-cup (120 mL) 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 patient is experiencing mild hypoglycemia. For mild hypoglycemic
manifestations, the nurse would administer oral glucose in the form of orange juice. If
the symptoms do not resolve immediately, the treatment would be repeated. The
patient does not need intravenous dextrose, insulin, or glucagon.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Diabetes mellitus, Complications MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
3. A nurse reviews the laboratory results of a client who is receiving intravenous insulin.
Which would alert the nurse to intervene immediately?
a. Serum chloride level of 98 mEq/L (98 mmol/L)
b. Serum calcium level of 8.8 mg/dL (2.2 mmol/L)
c. Serum sodium level of 132 mEq (132 mmol/L)
d. Serum potassium level of 2.5 mEq/L (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 TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Diabetes mellitus, Drug therapy MSC:
Client Needs Category: Physiological Integrity: Reduction of Risk Potential
, 4. A nurse teaches a client with diabetes mellitus about sick-day management. Which
statement would the nurse include in this client’s 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: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Diabetes mellitus, Complications MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
5. The nurse is caring for a client who has diabetes mellitus. The nurse administers 6
units of regular insulin and 10 units of NPH insulin at 7:00 a.m. (0700). At which time
would the nurse assess the client for potential hypoglycemia related to the NPH
insulin?
a. 8:00 a.m. (0800)
b. 4:00 p.m. (1600)
c. 8:00 p.m. (2000)
d. 11:00 p.m. (2300)
ANS: 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 patient at 2000 and 2300 would be too
late. The nurse would check the patient at 1600 (4:00 p.m.).
