Welcome to your ultimate diabetes NCLEX questions and reviewer! Answer all the diabetes mellitus practice questions (100 items) from our nursing test bank and test your competence in the nursing management of diabetes.
Diabetes Mellitus Nursing Test Bank
In this section are the practice NCLEX quiz for diabetes mellitus. This 100-item quiz will test your knowledge and ability to differentiate the different types of diabetes mellitus, recognizing the clinical manifestations and signs and symptoms of complications, medical management, nursing management, and patient education.
Quizzes included in this guide are:
- Part 1: Diabetes Mellitus NCLEX Questions (25 Items)
- Part 2: Diabetes Mellitus NCLEX Questions (25 Items)
- Part 3: Diabetes Mellitus NCLEX Questions (25 Items)
- Part 4: Diabetes Mellitus NCLEX Questions (25 Items)
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Diabetes Mellitus NCLEX Questions (Part 3: 25 Items)
This is the third part of your diabetes NCLEX questions review. Included in this set are 25 practice questions. Ready. Set. Go!
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Question 1 of 25
Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include?CorrectIncorrect
Question 2 of 25
Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication?CorrectIncorrect
Question 3 of 25
Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client’s additional insulin vials are not refrigerated. What is the best action by the nurse at this time?CorrectIncorrect
Question 4 of 25
During the morning rounds, Nurse AJ accompanied the physician in every patient’s room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician?CorrectIncorrect
Question 5 of 25
Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement?CorrectIncorrect
Question 6 of 25
The principal goals of therapy for older patients who have poor glycemic control are:CorrectIncorrect
Question 7 of 25
Which of the following is accurate pertaining to physical exercise and type 2 diabetes mellitus?CorrectIncorrect
Question 8 of 25
Harry is a diabetic patient who is experiencing a reaction to alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following?CorrectIncorrect
Question 9 of 25
Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to:CorrectIncorrect
Question 10 of 25
Rosemary has been taking glargine (Lantus) to treat her condition. One of the benefits of glargine (Lantus) insulin is its ability to:CorrectIncorrect
Question 11 of 25
A 50-year-old widower 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?CorrectIncorrect
Question 12 of 25
An older woman with diabetes mellitus visits the clinic concerning her condition. Which of the following symptoms might an older woman with diabetes mellitus complain?CorrectIncorrect
Question 13 of 25
Gregory is a 52-year-old man identified as high-risk for diabetes mellitus. Which laboratory test should a nurse anticipate a physician would order for him? Select all that apply.CorrectIncorrect
Question 14 of 25
According to the National Diabetes Statistics Report, diabetes remains one of the leading causes of death in the United States since 2010. Which of the following factors are risks for the development of diabetes mellitus? Select all that apply.CorrectIncorrect
Question 15 of 25
During a visit to the hospital, the student nurses are asked which of the following persons would most likely be diagnosed with diabetes mellitus. They are correct if they answered a 44-year-old:CorrectIncorrect
Question 16 of 25
An ailing 70-year-old woman 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?CorrectIncorrect
Question 17 of 25
After suffering an acute MI, a client with a history of type 1 diabetes is prescribed metoprolol (Lopressor) I.V. Which nursing interventions are associated with I.V. administration of metoprolol? Select all that apply.CorrectIncorrect
Question 18 of 25
When reviewing the urinalysis report of a client with newly diagnosed diabetes mellitus, the nurse would expect which urine characteristics to be abnormal? Select all that apply.CorrectIncorrect
Question 19 of 25
The nurse is admitting a client with newly diagnosed diabetes mellitus and left-sided heart failure. Assessment reveals low blood pressure, increased respiratory rate and depth, drowsiness, and confusion. The client complains of headache and nausea. Based on the serum laboratory results below, how would the nurse interpret the client’s acid-base balance?
HCO3-: 19 mEq/L
PaCO2: 35 mm Hg
PaO2: 88 mm Hg
Potassium: 5.3 mEq/L
Chloride: 102 mEq/L
Calcium: 10.4 mg/dl
Anion gap: 30 mEq/LCorrectIncorrect
Question 20 of 25
A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology?CorrectIncorrect
Question 21 of 25
During the lecture, the clinical instructor tells the students that 50% to 60% of daily calories should come from carbohydrates. What should the nurse say about the types of carbohydrates that can be eaten?CorrectIncorrect
Question 22 of 25
At the time Cherrie Ann found out that the symptoms of diabetes were caused by high levels of blood glucose, she decided to break the habit of eating carbohydrates. With this, the nurse would be aware that the client might develop which of the following complications?CorrectIncorrect
Question 23 of 25
Joko has recently been diagnosed with type 1 Diabetes Mellitus and asks nurse Jessica for help formulating a nutrition plan. Which of the following recommendations would the nurse make to help the client increase calorie consumption to offset absorption problems?CorrectIncorrect
Question 24 of 25
Billy is being asked concerning his health in the emergency department. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about the history of:CorrectIncorrect
Question 25 of 25
Nurse Shey is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply.CorrectIncorrect
Review Notes for Diabetes Mellitus
If you need a quick review around the concepts of diabetes mellitus, please see the refresher below:
- Diabetes mellitus is a disorder characterized by insufficient production of insulin in the pancreas or when there is a resistance or deficiency of available insulin resulting in hyperglycemia.
- It is characterized by disturbances in carbohydrate, protein, and fat metabolism.
- Sustained hyperglycemia has been shown to affect almost all tissues in the body and is associated with significant complications of multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.
- Type 1 diabetes mellitus or, formerly called insulin-dependent diabetes mellitus, typically occurs in younger people with the exact cause is unknown. Type 1 diabetes may result from an autoimmune process triggered by a virus
- Type 2 diabetes mellitus, formerly called non-insulin dependent diabetes mellitus, is characterized by defects in insulin release and use, and insulin resistance. Commonly occurs in patients with obesity and those with genetic susceptibility to DM.
- Gestational diabetes mellitus is characterized by glucose intolerance of any degree that occurs during pregnancy.
- Type 1 diabetes mellitus:
- There is a destruction of the islet cells in the pancreas causing insufficient insulin and excess glucagon.
- Glucose accumulates in the serum causing hyperglycemia.
- Blood being delivered in the kidneys has high glucose concentration causing osmotic diuresis and glycosuria.
- Osmotic diuresis causes water loss, resulting in polydipsia.
- Lack of insulin makes the body unable to use carbohydrates primarily and instead uses fats and proteins for energy production, resulting in ketosis and weight loss.
- Polyphagia and fatigue result from the break down of nutritional stores.
- Type 2 diabetes mellitus:
- Insulin resistance occurs in diabetes mellitus, wherein there is a decrease in tissue sensitivity to insulin.
- In normal conditions, insulin binds to special receptors on the cell surfaces and initiates reactions involved in glucose metabolism. However, in type 2 diabetes, these intracellular reactions are diminished, making insulin less effective at stimulating glucose uptake by the tissues and at regulating glucose release by the liver.
- If the beta cells cannot keep up with the increased demand for insulin, the glucose level rises and type 2 diabetes develops.
- Gestational diabetes mellitus:
- Hyperglycemia develops in pregnancy because of the secretion of placental hormones, which causes insulin resistance.
- Gestational diabetes is related to the anti-insulin effects of progesterone, cortisol, and human placenta lactogen, which increase the amount of insulin needed to maintain glycemic control.
- Hypoglycemia is when the blood the glucose falls to less than 50 to 60 mg/dL and is linked to excessive use of hypoglycemic agents, decreased food intake, increased physical activity, excessive alcohol consumption, or renal failure. It often occurs before meals, especially if meals are delayed or snacks are omitted. It can occur on type 1 or type 2 diabetes.
- Diabetic ketoacidosis (DKA) is caused by an absence or severe inadequacy of insulin. This deficit in available insulin results in disorders in the metabolism of carbohydrate, protein, and fat. DKA is usually associated with incorrect or failure to take insulin as prescribed and stress and is occurring in clients with type 1 diabetes.
- Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) is the combination of severe hyperglycemia and hyperosmolarity with little or no acidosis. The insulin level in HHNS is too low to prevent hyperglycemia but is high enough to prevent fat breakdown. HHNS occurs in older clients (50 to 70 years old) with type 2 diabetes and is associated with stress or ingestion of certain drugs.
- Microangiopathy, or diabetic microvascular disease, is characterized by capillary basement membrane thickening most prominently in the retina and glomerulus.
- Diabetic retinopathy is the deterioration of the small blood vessels that nourish the retina causing visual impairment.
- Nephropathy is a renal dysfunction caused by microvascular changes in the kidney secondary to diabetes mellitus.
- Diabetic neuropathy refers to a group of diseases that affect all types of nerves characterized by paresthesias or decreased sensation. Peripheral neuropathy and autonomic neuropathy are two of the most common types of neuropathy found in diabetes.
- Increased susceptibility to infections results from an impaired ability of granulocytes to respond to infectious agents.
- Diabetes mellitus:
- Polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased appetite) are the classic symptoms of diabetes mellitus, also known as the “3 P’s of DM”.
- Fatigue and weakness
- Weight loss
- Sudden vision changes
- Tingling or numbness in hands or feet
- Dry skin
- Skin lesions or wounds that are slow to heal
- Recurrent infections (urinary, skin, vulva)
- Diabetic Ketoacidosis (DKA)
- Kussmaul’s respirations
- Nausea and vomiting
- Abdominal pain
- Acetone breath (fruity odor)
- Decreased level of consciousness
- Orthostatic hypotension
- Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
- Dehydration (dry mucous membranes, poor skin turgor)
- Decreased level of consciousness (altered sensorium, seizures, hemiparesis)
- Mild hypoglycemia: stimulation of the sympathetic nervous system.
- Cool, moist skin, or pallor
- Moderate hypoglycemia: decreased glucose levels for the brain cells.
- Impaired CNS function
- Inability to concentrate
- Memory lapses
- Double vision
- Severe hypoglycemia: severe impairment of the CNS.
- Disoriented behavior
- Difficulty arousing from sleep
- Loss of consciousness
- Mild hypoglycemia: stimulation of the sympathetic nervous system.
Laboratory and Diagnostics
- Diabetes mellitus
- Fasting blood glucose level above 140 mg/dL or postprandial (after meals) blood glucose levels above 200 mg/dl measured on more than one occasion is diagnostic.
- Glycosylated hemoglobin (HgbA1C) shows an elevated blood glucose level.
- Diabetic ketoacidosis (DKA)
- Blood glucose levels between 300 and 8900 mg/dL
- Ketoacidosis is reflected in low serum bicarbonate (0 to 15 mEq/L) and low pH values.
- Accumulation of ketone bodies is reflected in blood and urine ketone measurements.
- Sodium and potassium concentrations may vary depending on the degree of dehydration. Increased levels of creatinine, blood urea nitrogen, and hematocrit go along with dehydration.
- Arterial blood gas indicate metabolic acidosis
- Serum blood glucose higher than 700 mg/dL
- Serum blood osmolality is higher than 350 mOsm/kg
- Urine specimen reveals the absence of ketosis
- Serum electrolyte levels show hypernatremia and hypokalemia.
- Serum blood glucose level is less than 70 mg/dL
- The main goal of treatment is to normalize insulin activity and blood glucose levels to reduce the development of complications.
- There are five components of management for diabetes: nutrition, exercise, monitoring, pharmacologic therapy, and education.
- Insulin is the primary treatment for type 1 diabetes.
- Weight reduction is the primary treatment for type 2 diabetes.
- Exercise enhances the effectiveness of insulin.
- Monitor blood glucose levels and provide teaching to the patient on how to do so.
- Administer medications, as prescribed:
- Insulin for type 1 diabetes
- Hypoglycemic agents for type 2 diabetes (sulfonylureas, thiazolidinediones, biguanides, alpha-glucosidase inhibitors)
- Self-administering insulin
- Provide information and teaching on how to self-administer insulin.
- On storing insulin: vials of insulin, when not in use, should be refrigerated (extreme temperatures should also be avoided). Insulin vial that is currently in use can be kept at room temperature (1 month). Cloudy insulins should be thoroughly mixed by gently inverting the vial or rolling it between the hands before drawing the solution. Intermediate-acting insulin showing a frosted, whitish coating inside the bottle, should be discarded.
- On selecting syringes: syringes should match the insulin concentration.
- On mixing insulins: patients should be warned not to inject one type of insulin into the bottle containing a different type of insulin. Patients with difficulty mixing insulins may use premixed insulin.
- Selecting and rotating injection sites: the abdomen, upper arms, thighs, and hips are the four main sites for insulin injection. Rotation of injection sites is recommended to prevent lipodystrophy which may cause a decrease in the absorption of insulin. Encourage the patient to use all available injection sites within one area rather than randomly rotating sites from area to area.
- Inserting the needle: insulin should be injected into the subcutaneous tissue, the incorrect technique may affect the rate of absorption.
- Nurse teaching on diabetes
- Assess readiness to learn and include the patient’s family in developing a diabetic teaching plan.
- Prevention of complications
- Dietary and lifestyle changes
- Proper self-care (especially foot care)
- Administration and management of insulin
- Use of hypoglycemic medications
- Management of DKA.
- Treatment goal is to prevent dehydration, electrolyte loss, and acidosis.
- Normal saline (0.9%) is infused at a high rate to replace fluid loss. Hypotonic solution (0.45% NS) may be used for hypertension or hypernatremia.
- Administer regular insulin, as ordered.
- Monitor serum glucose levels as insulin is administered.
- Monitor potassium levels, because potassium shifts affect the heart.
- Monitor respirations as respiratory distress can occur.
- Assess vital signs, intake and output, and monitor ketone levels.
- Management of HHNS.
- Assess vital signs, fluid status, and laboratory values. Fluid status and urine output are closely monitored because of the risk for renal failure secondary to severe dehydration.
- Because clients are usually older, monitor for heart failure and cardiac arrhythmias.
- Management of Hypoglycemia.
- Monitor blood glucose levels.
- Administer glucose (oral glucose, I.V. glucose, or glucagon).
- Advise client to carry simple sugar at all times to prevent case of hypoglycemia.
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