NURS 502 Final (New PQ)
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic coma. -
ANS-C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood
glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe
as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing
or after a patient develops complications such as frequent yeast infections.
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7
mmol/L). What should the nurse plan to teach the patient?
a. Self-monitoring of blood glucose
b. Using low doses of regular insulin
c. Lifestyle changes to lower blood glucose
d. Effects of oral hypoglycemic medications - ANS-C
The patient's impaired fasting glucose indicates prediabetes, and the patient should be
counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient
with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not
need to self-monitor blood glucose.
A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose
control. Which behavior indicates that the nurse should implement additional teaching?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine. - ANS-D
When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients
with type 1 diabetes should be taught to avoid exercise when ketosis is present. The other
statements are correct.
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from
now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the
patient?
a. Fasting blood glucose
b. Hemoglobin A1c
c. Oral glucose tolerance test
d. Urine dipstick for glucose and ketones - ANS-B
,HbA1c test shows the overall control of glucose over 90 to 120 days. A fasting blood level
indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of
blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose
tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control
after diabetes has been diagnosed.
The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass
index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient?
a. The patient will reach a HbA1c of less than 7%.
b. The patient will follow a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet. - ANS-A
The complications of diabetes are related to elevated blood glucose and the most important
patient outcome is the reduction of glucose to near-normal levels. A BMI of 30.9/kg/m2 or above
is considered obese, so the other outcomes are appropriate but are not as high in priority.
Which statement by the patient who has newly diagnosed type 1 diabetes indicates a need for
additional instruction from the nurse?
a. "I will need a bedtime snack because I take an evening dose of NPH insulin."
b. "I can choose any foods, as long as I use enough insulin to cover the calories."
c. "I can have an occasional beverage with alcohol if I include it in my meal plan."
d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry." -
ANS-B
Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are
using intensified insulin therapy have considerable flexibility in diet choices but still should
restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are
correct and indicate good understanding of the diet instruction.
Which nursing action is most important in assisting an older patient who has diabetes to engage
in moderate daily exercise?
a. Determine what types of activities the patient enjoys.
b. Remind the patient that exercise improves self-esteem.
c. Teach the patient about the effects of exercise on glucose level.
d. Give the patient a list of activities that are moderate in intensity. - ANS-A
Because consistency with exercise is important, assessment for the types of exercise that the
patient finds enjoyable is the most important action by the nurse in ensuring adherence to an
exercise program. The other actions may be helpful but are not the most important in improving
compliance.
Which patient statement to the nurse indicates a need for additional instruction in administering
insulin?
a. "I can buy the 0.5-mL syringes because the line markings are easier to see."
b. "I need to rotate injection sites among my arms, legs, and abdomen each day."
c. "I do not need to aspirate the plunger to check for blood before injecting insulin."
,d. "I should draw up the regular insulin first, after injecting air into the NPH bottle." - ANS-B
Rotating sites is no longer recommended because there is more consistent insulin absorption
when the same site is used consistently. The other patient statements are accurate and indicate
that no additional instruction is needed.
Which patient action indicates accurate understanding of the nurse's teaching about
administration of aspart (NovoLog) insulin?
a. The patient avoids injecting the insulin into the upper abdominal area.
b. The patient cleans the skin with soap and water before insulin administration.
c. The patient stores the insulin in the freezer after administering the prescribed dose.
d. The patient pushes the plunger down while removing the syringe from the
injection site. - ANS-B
Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient
should leave the syringe in place for about 5 seconds after injection to be sure that all the
insulin has been injected. The upper abdominal area is one of the preferred areas for insulin
injection.
A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse
anticipate the highest risk for hypoglycemia?
a. 10:00 AM
b. 12:00 AM
c. 2:00 PM
d. 4:00 PM - ANS-A
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia
at the other listed times, although hypoglycemia may occur.
Which patient action indicates an accurate understanding of the nurse's teaching about the use
of an insulin pump?
a. The patient programs the pump for an insulin bolus after eating.
b. The patient changes the location of the insertion site every week.
c. The patient takes the pump off at bedtime and starts it again each morning.
d. The patient plans a diet with more calories than usual when using the pump. - ANS-A
In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a
bolus after each meal, with the dosage depending on the oral intake. The insertion site should
be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin
pump is used, but it does not provide for consuming a higher calorie diet. The pump will deliver
a basal insulin rate 24 hours a day.
A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the
nurse discuss using for mealtime coverage?
a. Lispro (Humalog)
b. Glargine (Lantus)
c. Detemir (Levemir)
d. NPH (Humulin N) - ANS-A
, Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive
insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
The nurse has been teaching a patient with type 2 diabetes about managing blood glucose
levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional
teaching?
a. "If I overeat at a meal, I will still take the usual dose of medication."
b. "Other medications besides the Glucotrol may affect my blood sugar."
c. "When I am ill, I may have to take insulin to control my blood sugar."
d. "My diabetes won't cause complications because I don't need insulin." - ANS-D
The patient should understand that type 2 diabetes places the patient at risk for many
complications and that good glucose control is as important when taking oral agents as when
using insulin. The other statements are accurate and indicate good understanding of the use of
glipizide.
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an
allergic rash from an unknown cause, the health care provider prescribes prednisone. What
should the nurse anticipate?
a. The patient may need a diet higher in calories while receiving prednisone.
b. The patient may develop acute hypoglycemia while taking the prednisone.
c. The patient may require administration of insulin while taking prednisone.
d. The patient may have rashes caused by metformin-prednisone interactions. - ANS-C
Glucose levels increase when patients are taking corticosteroids, and insulin may be required to
control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an
adverse effect caused by taking metformin and prednisone simultaneously. The patient may
have an increased appetite when taking prednisone but will not need a diet that is higher in
calories.
A hospitalized patient who is diabetic received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, he
patient has been away from the nursing unit for 2 hours, missing the lunch delivery while
awaiting a chest x-ray. What is the best action by the nurse to prevent hypoglycemia?
a. Plan to discontinue the evening dose of insulin.
b. Save the lunch tray for the patient's later return.
c. Request that if testing is further delayed, the patient will eat lunch first.
d. Send a glass of orange juice to the patient in the diagnostic testing area. - ANS-C
Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the
patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause
hypoglycemia. Holding the insulin dose later will not prevent hypoglycemia form the peak of the
NPH dose. A glass of juice will keep the patient from becoming hypoglycemic but will cause a
rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these
items.
Which action by the patient who is self-monitoring blood glucose indicates a need for additional
teaching?
Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic coma. -
ANS-C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood
glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe
as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing
or after a patient develops complications such as frequent yeast infections.
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7
mmol/L). What should the nurse plan to teach the patient?
a. Self-monitoring of blood glucose
b. Using low doses of regular insulin
c. Lifestyle changes to lower blood glucose
d. Effects of oral hypoglycemic medications - ANS-C
The patient's impaired fasting glucose indicates prediabetes, and the patient should be
counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient
with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not
need to self-monitor blood glucose.
A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose
control. Which behavior indicates that the nurse should implement additional teaching?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine. - ANS-D
When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients
with type 1 diabetes should be taught to avoid exercise when ketosis is present. The other
statements are correct.
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from
now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the
patient?
a. Fasting blood glucose
b. Hemoglobin A1c
c. Oral glucose tolerance test
d. Urine dipstick for glucose and ketones - ANS-B
,HbA1c test shows the overall control of glucose over 90 to 120 days. A fasting blood level
indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of
blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose
tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control
after diabetes has been diagnosed.
The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass
index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient?
a. The patient will reach a HbA1c of less than 7%.
b. The patient will follow a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet. - ANS-A
The complications of diabetes are related to elevated blood glucose and the most important
patient outcome is the reduction of glucose to near-normal levels. A BMI of 30.9/kg/m2 or above
is considered obese, so the other outcomes are appropriate but are not as high in priority.
Which statement by the patient who has newly diagnosed type 1 diabetes indicates a need for
additional instruction from the nurse?
a. "I will need a bedtime snack because I take an evening dose of NPH insulin."
b. "I can choose any foods, as long as I use enough insulin to cover the calories."
c. "I can have an occasional beverage with alcohol if I include it in my meal plan."
d. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry." -
ANS-B
Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are
using intensified insulin therapy have considerable flexibility in diet choices but still should
restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are
correct and indicate good understanding of the diet instruction.
Which nursing action is most important in assisting an older patient who has diabetes to engage
in moderate daily exercise?
a. Determine what types of activities the patient enjoys.
b. Remind the patient that exercise improves self-esteem.
c. Teach the patient about the effects of exercise on glucose level.
d. Give the patient a list of activities that are moderate in intensity. - ANS-A
Because consistency with exercise is important, assessment for the types of exercise that the
patient finds enjoyable is the most important action by the nurse in ensuring adherence to an
exercise program. The other actions may be helpful but are not the most important in improving
compliance.
Which patient statement to the nurse indicates a need for additional instruction in administering
insulin?
a. "I can buy the 0.5-mL syringes because the line markings are easier to see."
b. "I need to rotate injection sites among my arms, legs, and abdomen each day."
c. "I do not need to aspirate the plunger to check for blood before injecting insulin."
,d. "I should draw up the regular insulin first, after injecting air into the NPH bottle." - ANS-B
Rotating sites is no longer recommended because there is more consistent insulin absorption
when the same site is used consistently. The other patient statements are accurate and indicate
that no additional instruction is needed.
Which patient action indicates accurate understanding of the nurse's teaching about
administration of aspart (NovoLog) insulin?
a. The patient avoids injecting the insulin into the upper abdominal area.
b. The patient cleans the skin with soap and water before insulin administration.
c. The patient stores the insulin in the freezer after administering the prescribed dose.
d. The patient pushes the plunger down while removing the syringe from the
injection site. - ANS-B
Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient
should leave the syringe in place for about 5 seconds after injection to be sure that all the
insulin has been injected. The upper abdominal area is one of the preferred areas for insulin
injection.
A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse
anticipate the highest risk for hypoglycemia?
a. 10:00 AM
b. 12:00 AM
c. 2:00 PM
d. 4:00 PM - ANS-A
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia
at the other listed times, although hypoglycemia may occur.
Which patient action indicates an accurate understanding of the nurse's teaching about the use
of an insulin pump?
a. The patient programs the pump for an insulin bolus after eating.
b. The patient changes the location of the insertion site every week.
c. The patient takes the pump off at bedtime and starts it again each morning.
d. The patient plans a diet with more calories than usual when using the pump. - ANS-A
In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a
bolus after each meal, with the dosage depending on the oral intake. The insertion site should
be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin
pump is used, but it does not provide for consuming a higher calorie diet. The pump will deliver
a basal insulin rate 24 hours a day.
A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the
nurse discuss using for mealtime coverage?
a. Lispro (Humalog)
b. Glargine (Lantus)
c. Detemir (Levemir)
d. NPH (Humulin N) - ANS-A
, Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive
insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
The nurse has been teaching a patient with type 2 diabetes about managing blood glucose
levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional
teaching?
a. "If I overeat at a meal, I will still take the usual dose of medication."
b. "Other medications besides the Glucotrol may affect my blood sugar."
c. "When I am ill, I may have to take insulin to control my blood sugar."
d. "My diabetes won't cause complications because I don't need insulin." - ANS-D
The patient should understand that type 2 diabetes places the patient at risk for many
complications and that good glucose control is as important when taking oral agents as when
using insulin. The other statements are accurate and indicate good understanding of the use of
glipizide.
When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an
allergic rash from an unknown cause, the health care provider prescribes prednisone. What
should the nurse anticipate?
a. The patient may need a diet higher in calories while receiving prednisone.
b. The patient may develop acute hypoglycemia while taking the prednisone.
c. The patient may require administration of insulin while taking prednisone.
d. The patient may have rashes caused by metformin-prednisone interactions. - ANS-C
Glucose levels increase when patients are taking corticosteroids, and insulin may be required to
control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an
adverse effect caused by taking metformin and prednisone simultaneously. The patient may
have an increased appetite when taking prednisone but will not need a diet that is higher in
calories.
A hospitalized patient who is diabetic received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, he
patient has been away from the nursing unit for 2 hours, missing the lunch delivery while
awaiting a chest x-ray. What is the best action by the nurse to prevent hypoglycemia?
a. Plan to discontinue the evening dose of insulin.
b. Save the lunch tray for the patient's later return.
c. Request that if testing is further delayed, the patient will eat lunch first.
d. Send a glass of orange juice to the patient in the diagnostic testing area. - ANS-C
Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the
patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause
hypoglycemia. Holding the insulin dose later will not prevent hypoglycemia form the peak of the
NPH dose. A glass of juice will keep the patient from becoming hypoglycemic but will cause a
rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these
items.
Which action by the patient who is self-monitoring blood glucose indicates a need for additional
teaching?
