Forget past mistakes. Forget failures. Forget everything except what you’re going to do now and do it.
~ William Durant
Included topics in this practice quiz are:
- Diabetes Mellitus
- Diagnostic Procedures about DM
- Management and Care of Patients with DM
Follow the guidelines below to make the most out of this exam:
- Read each question carefully and choose the best answer.
- You are given one minute per question. Spend your time wisely!
- Answers and rationales are given below. Be sure to read them.
- If you need more clarifications, please direct them to the comments section.
In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.You are given 1 minute per question, a total of 30 minutes for this exam.
NCLEX Exam: Diabetes Mellitus 2 (30 Items)
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NCLEX Exam: Diabetes Mellitus 2 (30 Items)
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In Text Mode: All questions and answers are given for reading and answering at your own pace. You can also copy this exam and make a printout.
1. Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this means. What is the best response by the nurse? Select all that apply.
A. “Your alpha cells should be able to secrete insulin, but cannot.”
B. “The exocrine function of your pancreas is to secrete insulin.”
C. “Without insulin, you will develop ketoacidosis (DKA).”
D. “The endocrine function of your pancreas is to secrete insulin.”
E. “It means your pancreas cannot secrete insulin.”
2. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply.
A. The nurse could have given the insulin subcutaneously.
B. The nurse should have contacted the physician.
C. The nurse should have used regular insulin (Humulin R).
D. The nurse used the correct insulin.
3. Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal?
A. The client will be very thirsty.
B. The client will complain of nausea.
C. The client will need to urinate.
D. The client will have moist skin.
4. A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes?
A. The 50-year-old client who does not get any physical exercise
B. The 56-year-old client who drinks three glasses of wine each evening
C. The 42-year-old client who is 50 pounds overweight
D. The 38-year-old client who smokes one pack of cigarettes per day
5. Steven John has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess?
B. AST (aspartate aminotransferase)
C. Serum amylase
6. Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with regard to patient education with this drug? Select all that apply.
A. It stimulates the pancreas to produce more insulin.
B. It must be taken with meals.
C. It decreases sugar production in the liver.
D. It inhibits absorption of carbohydrates.
E. It reduces insulin resistance.
7. Serafica who has diabetes mellitus type 1 is found unresponsive in the clinical setting. Which nursing action is a priority? arrange from 1 to 4.
1. Treat the client for hypoglycemia.
2. Call the physician STAT.
3. Assess the vital signs.
4. Call a code.
A. 1, 2, 3, 4
B. 1, 3, 2, 4
C. 3, 1, 2, 4
D. 4, 3, 2, 1
8. Serge who has diabetes mellitus is taking oral agents, and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications?
A. Administer the oral agents immediately after the test.
B. Notify the the diagnostic department and request orders.
C. Notify the physician and request orders.
D. Administer the oral agents with a sip of water before the test.
9. A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can’t just take pills instead. What is the best response by the nurse?
A. “Insulin must be injected because it needs to work quickly.”
B. “Insulin can’t be in a pill because it is destroyed in stomach acid.”
C. “Have you talked to your doctor about taking pills instead?”
D. “I know it is tough, but you will get used to the shots soon.”
10. Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin. He evaluates the learning has occurred when the client makes which statement?
A. “I should check my blood sugar immediately prior to the administration.”
B. “I should provide direct pressure over the site following the injection.”
C. “I should use the abdominal area only for insulin injections.”
D. “I should only use calibrated insulin syringe for the injections.”
11. 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?
A. The alcohol could cause pancreatic disease.
B. The alcohol could cause serious liver disease.
C. The alcohol could predispose you to hypoglycemia.
D. The alcohol could predispose you to hyperglycemia.
12. Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication?
A. When the client is eating
B. Thirty minutes before meals
C. fifteen minutes before meals
D. When the meal trays arrive on the floor
13. 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?
A. Instruct the client to label each vial with the date when opened.
B. Tell the client there is no need to keep additional vials.
C. Have the client place the insulin vials in the refrigerator.
D. Have the client discard the vials.
14. 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?
A. Use Humalog insulin for sliding scale coverage.
B. Metformin (Glucophage) 1000 mg per day in divided doses.
C. Administer regular insulin 30 minutes prior to meals.
D. Lantus insulin 20U BID.
15. Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement?
A. “My cells have increased their receptors, but there is enough insulin.”
B. “My peripheral cells have increased sensitivity to insulin.”
C. “My beta cells cannot produce enough insulin for my cells.”
D. “My cells cannot use the insulin my pancreas makes.”
16. The principal goals of therapy for older patients who have poor glycemic control are:
A. Enhancing quality of life.
B. Decreasing the chance of complications.
C. Improving self-care through education.
D. All of the above.
17. Which of the following is accurate pertaining to physical exercise and type 1 diabetes mellitus?
A. Physical exercise can slow the progression of diabetes mellitus.
B. Strenuous exercise is beneficial when the blood glucose is high.
C. Patients who take insulin and engage in strenuous physical exercise might experience hyperglycemia.
D. Adjusting insulin regimen allows for safe participation in all forms of exercise.
18. Harry is a diabetic patient who is experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following?
A. Uncontrolled diabetes
B. Somogyi phenomenon
C. Brittle diabetes
D. Diabetes insipidus
19. 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:
A. Induce hypoglycemia by decreasing insulin sensitivity.
B. Improve insulin sensitivity and decrease hyperglycemia.
C. Stimulate the beta cells of the pancreas to secrete insulin.
D. Decrease insulin sensitivity by enhancing glucose uptake.
20. Rosemary has been taking Glargine (Lantus) to treat her condition. One of the benefits of Glargine (Lantus) insulin is its ability to:
A. Release insulin rapidly throughout the day to help control basal glucose.
B. Release insulin evenly throughout the day and control basal glucose levels.
C. Simplify the dosing and better control blood glucose levels during the day.
D. Cause hypoglycemia with other manifestation of other adverse reactions.
21. 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?
22. An older woman with diabetes mellitus visits the clinic concerning her condition. Of which of the following symptoms might an older woman with diabetes mellitus complain?
B. Pain intolerance
C. Weight loss
D. Perineal itching
23. 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.)
A. Fasting Plasma Glucose (FPG)
B. Two-hour Oral Glucose Tolerance Test (OGTT)
C. Glycosylated hemoglobin (HbA1C)
D. Finger stick glucose three times daily
24. According to the National Diabetes Statistics Report, diabetes remains as 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.)
A. Age over 45 years
B. Overweight with a waist/hip ratio >1
C. Having a consistent HDL level above 40 mg/dl
D. Maintaining a sedentary lifestyle
25. During a visit in 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:
A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.
26. 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?
A. Insulin resistance has developed.
B. Diabetic ketoacidosis is occurring.
C. Hypoglycemia unawareness is developing.
D. Hyperglycemic hyperosmolar non-ketotic coma.
27. Daniel is diagnosed of having hyperthyroidism (Graves’ disease). Which of the following is a drug of choice for his condition?
28. Which of the following medications are most likely to cause hypothyroidism? (Select all that apply.)
29. After visiting the physician, Angela found out that she has a thyroid problem. In line with her condition, which of the following diagnostic studies is done to determine the size and composition of the thyroid gland?
A. Thyroid scan with RAI 123I
D. Venous duplex Doppler study
A. High risk for aspiration related to severe vomiting
B. Diarrhea related to increased peristalsis
C. Hypothermia related to slowed metabolic rate
D. Oral mucous membrane, altered related to disease process
Answers and Rationale
Here are the answers for this exam. Gauge your performance by counter checking your answers to those below. If you have any disputes or clarifications, please direct them to the comments section.
1. Answer: C, D, E
One function of your pancreas is to secrete insulin. The endocrine function of the pancreas is to secrete insulin. The endocrine, not the exocrine, function of the pancreas is to secrete insulin. Insulin is secreted by the beta, not the alpha, cells of the pancreas. A consequence of diabetes mellitus type 1 is that without insulin, severe metabolic disturbances, such as ketoacidosis (DKA) will result.
2. Answer: B, C
Regular insulin is the only insulin that can be given intravenously (IV). The nurse did not use correct insulin as it was not regular insulin. Contact the provider to clarify the order, regular insulin is the only insulin that can be given intravenously (IV). The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV).
3. Answer: D. The client will have moist skin.
Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat. Thirst, nausea, and increased urination are signs of hyperglycemia.
4. Answer: C. The 42-year-old client who is 50 pounds overweight
Obesity increases the likelihood of developing diabetes mellitus due to over stimulation of the endocrine system. Exercise is important, but lack of exercise is not as big a risk factor as obesity. Smoking is a serious health concern but is not a specific risk factor for diabetes. Consuming alcohol is associated with liver disease but is not as high a risk factor for diabetes as obesity.
5. Answer: A. Potassium
Insulin causes potassium to move into the cell and may cause hypokalemia. There is no need to monitor the sodium, serum amylase, and AST levels.
6. Answer: B, C, E
Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect. It does not stimulate the pancreas to produce more insulin and does not inhibit the absorption of carbohydrates.
7. Answer: A. 1, 2, 3, 4
When a patient with diabetes mellitus type 1 is unresponsive, the nurse should focus on and treat for hypoglycemia, as this is more likely than hyperglycemia. This is an emergency situation where the nurse must act before calling the physician. Vital signs should be taken after the client is treated for hypoglycemia. Assessment for ABCs should precede calling a code; there is no information that the client is not breathing.
8. Answer: C. Notify the physician and request orders.
It is best to notify the client’s physician and request orders. The client should not receive the medication during NPO status unless directed by the physician. The medications should not be given upon return unless the physician orders this; the client may still need to be NPO. The radiologist in the diagnostic department might give orders, but it would be best to check with the client’s physician first.
9. Answer: B. “Insulin can’t be in a pill because it is destroyed in stomach acid.”
Insulin must be injected because it is destroyed in the stomach acid if taken orally. Telling he will get used to shots does not answer his question and is condescending. Insulin must be injected because it is destroyed in stomach acid if taken orally; the onset of action is not the issue here. The nurse should answer the client’s question, not refer him back to the physician.
10. Answer: D. “I should only use calibrated insulin syringe for the injections.”
To ensure the correct insulin dose, a calibrated insulin syringe must be used. Insulin injections should be rotated to the arm and thigh, not just the abdominal area. There is no need to apply direct pressure over the site following an insulin injection. There is no need to check blood glucose immediately prior to the injection.
11. Answer: C. The alcohol could predispose you to hypoglycemia.
Alcohol can potentiate hypoglycemic, not hypoglycemic, effects in the client. Alcohol can cause pancreatic disease, but the client’s pancreas is not producing any insulin currently. Alcohol can cause liver disease, but the more immediate concern is hypoglycemia.
12. Answer: A. When the client is eating
The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia. It must be given when the client is eating, not when the meal trays arrive on the floor and not thirty minutes before meals.
13. Answer: C. Have the client place the insulin vials in the refrigerator.
Vials not in use should be refrigerated to preserve drug potency. There is no need to discard the vials. The client should always have additional vials of insulin available. Writing the date of opening on the vial is good practice, but does not address the need to refrigerate additional vials.
14. Answer: D. Lantus insulin 20U BID.
Lantus insulin is usually prescribed once-a-day so an order for BID dosing should be validated with the physician. Humalog insulin can be prescribed for sliding scale coverage. Regular insulin is administered 30 minutes before meals. Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day.
15. Answer: D. “My cells cannot use the insulin my pancreas makes.”
With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. Peripheral cells have a decreased, not an increased, sensitivity to insulin. The beta cells continue to produce insulin with type 2 diabetes. There is a decrease, not an increase, in receptor sites with type 2 diabetes.
16. Answer: D. All of the above.
The principal goals of therapy for older persons with diabetes mellitus and poor glycemic control are enhancing quality of life, decreasing the chance of complications, improving self-care through education, and maintaining or improving general health status.
17. Answer: A. Physical exercise can slow the progression of diabetes mellitus.
Physical exercise slows the progression of diabetes mellitus because exercise has beneficial effects on carbohydrate metabolism and insulin sensitivity. Strenuous exercise can cause retinal damage and can cause hypoglycemia. Insulin and foods both must be adjusted to allow safe participation in exercise.
18. Answer: B. Somogyi phenomenon
Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and increase in ketones.
19. Answer: C. Stimulate the beta cells of the pancreas to secrete insulin.
Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.
20. Answer: B. Release insulin evenly throughout the day and control basal glucose levels.
Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.
21. Answer: D. Pancreatic tumor
The onset of hyperglycemia in the older adult can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumor.
22. Answer: D. Perineal itching
Older women might complain of perineal itching due to vaginal candidiasis.
23. Answer: A, B
When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. An FPG greater than 140 mg/dL usually indicates diabetes. The OGTT is to determine how the body responds to the ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose control. A finger stick glucose three times daily spot-checks blood glucose levels.
24. Answer: A, B, D
Aging results in reduced ability of beta cells to respond with insulin effectively. Overweight with waist/hip ratio increase is part of the metabolic syndrome of DM II. There is an increase in atherosclerosis with DM due to the metabolic syndrome and sedentary lifestyle.
25. Answer: C. African-American woman.
Age-specific prevalence of diagnosed diabetes mellitus (DM) is higher for African-Americans and Hispanics than for Caucasians. Among those younger than 75, black women had the highest incidence.
26. Answer: D. Hyperglycemic hyperosmolar non-ketotic coma.
Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin.
27. Answer: D. Propylthiouracil (PTU)
Propylthiouracil (PTU) initially is given in divided doses, and functions to block thyroid hormone synthesis.
28. Answer: A, B, D
Acetylsalicylic acid (aspirin), Furosemide (Lasix), and Rifampin (Rifadin) are most likely to cause hypothyroidism.
29. Answer: C. Ultrasonography
Although thyroid scans frequently are done to evaluate the thyroid gland, I 123 is used to destroy overactive thyroid cells such as are seen in thyroid cancer. Ultrasonography can be used early in the evaluation process to rule out Graves’ disease, nodular goiter, or other thyroid dysfunction.
30. Answer: C. Hypothermia related to slowed metabolic rate
Thyroid hormone deficiency results in reduction in the metabolic rate, resulting in hypothermia, and does predispose the older adult to a host of other health-related issues. One-quarter of affected elderly experience constipation.
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