Diabetes Mellitus NCLEX Practice Quiz #3 (25 Questions)

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Diabetes Mellitus NCLEX-RN Practice Quiz #3 (25 Questions) - Nurseslabs

If you want to bulk up your learning about Diabetes Mellitus, this 25-item NCLEX style examination will help you boost your knowledge about the disease.

When I was young I observed that nine out of ten things I did were failures, so I did ten times more work.
~ Bernard Shaw

Topics

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Guidelines

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.

Questions

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NCLEX Exam: Diabetes Mellitus 3 (25 Items)

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NCLEX Exam: Diabetes Mellitus 3 (25 Items)

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1. During 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?

A. Try to limit simple sugars to between 10% and 20% of daily calories.
B. Simple carbohydrates are absorbed more rapidly than complex carbohydrates.
C. Simple sugars cause rapid spike in glucose levels and should be avoided.
D. Simple sugars should never be consumed by someone with diabetes.

2. 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 what complication?

A. retinopathy
B. atherosclerosis
C. glycosuria
D. acidosis

3. Joko has recently been diagnosed with Type I diabetes 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?

A. Eat small meals with two or three snacks throughout the day to keep blood glucose levels steady
B. Increase consumption of simple carbohydrates
C. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals.
D. Skip meals to help lose weight

4. 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 a history of

A. alcohol use.
B. cigarette smoking.
C. diabetes mellitus.
D. high-protein diet.

5. 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.

A. Cakes, candies, cookies, and regular soft drinks should be avoided.
B. Gestational diabetes increases the risk that the mother will develop diabetes later in life.
C. Gestational diabetes usually resolves after the baby is born.
D. Insulin injections may be necessary.
E. The baby will likely be born with diabetes
F. The mother should strive to gain no more weight during the pregnancy.

6. The goal for pre-prandial blood glucose for those with Type 1 diabetes mellitus is:

A. <80 mg/dl
B. <130 mg/dl
C. <180 mg/dl
D. <6%

7. The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus includes all of the following EXCEPT:

A. Flexibility in types and amounts of foods consumed
B. Unlimited intake of total fat, saturated fat and cholesterol
C. Including adequate servings of fruits, vegetables and the dairy group
D. Applicable to with either Type 1 or Type 2 diabetes mellitus

8. The nurse working in the physician’s office is reviewing lab results on the clients seen that day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma glucose (FPG) test done. The nurse realizes that diagnostic criteria developed by the American Diabetes Association for diabetes include classic diabetic symptoms plus which of the following fasting plasma glucose levels?

A. Higher than 106 mg/dl
B. Higher than 126 mg/dl
C. Higher than 140 mg/dl
D. Higher than 160 mg/dl

9. When taking a health history, the nurse screens for manifestations suggestive of Diabetes Type I. Which of the following manifestations are considered the primary manifestations of Diabetes Type I and would be most suggestive and require follow-up investigation?

A. Excessive intake of calories, rapid weight gain, and difficulty losing weight
B. An increase in three areas: thirst, intake of fluids, and hunger
C. Poor circulation, wound healing, and leg ulcers,
D. Lack of energy, weight gain, and depression

10. The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of Type II Diabetes and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents?

A. Comply with medication regimen 100% for 6 months
B. Quit the use of any tobacco products by the end of three months
C. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily
D. Practice relaxation techniques for at least five minutes five times a day for at least five months

11. During a visit in a community, the nurse will recommend routine screening for diabetes when the person has one or more of seven risk criteria. Which of the following persons that the nurse comes in contact with most needs to be screened for diabetes based on the seven risk criteria?

A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl
B. A woman who is at 90% of standard body weight after delivering an eight-pound baby
C. A middle-aged Caucasian male
D. An older client who is hypotensive

12. During the admission of a client with diabetic ketoacidosis, Nurse Kendra will anticipate the physician ordering which of the following types of intravenous solution if the client cannot take fluids orally?

A. Lactated Ringer’s solution
B. 0.9 normal saline solution
C. 5% dextrose in water (D5W)
D. 0.45% normal saline solution

13. You are doing some teaching with a client who is starting on a sulfonylurea antidiabetic agent. The client mentions that he usually has a couple of beers each night and takes an aspirin each day to prevent heart attack and/or strokes. Which of the following responses would be best on the part of the nurse?

A. As long as you only drink two beers and take one aspirin, this should not be a problem
B. The aspirin is alright but you need to give up drinking any alcoholic beverages
C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia
D. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

14. Which of the following if stated by the nurse is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?

A. This syndrome occurs mainly in people with Type I Diabetes
B. It has a higher mortality rate than Diabetic Ketoacidosis
C. The client with HHNS is in a state of overhydration
D. This condition develops very rapidly

15. Nurse Robedee is teaching a thin client about the proper methods/techniques when giving insulin. Which one of the following is proper?

A. Pinch the skin up and use a 90 degree angle
B. Use a 45 degree angle with the skin pinched up
C. Massage the area of injection after injecting the insulin
D. Warm the skin with a warmed towel or washcloth prior to the injection

16. Nurse Pira is explaining to the client about Type II Diabetes. Risk factors of such condition include all of the following except:

A. Advanced age
B. Physical inactivity
C. Obesity
D. Smoking

17. Blood sugar is well controlled when Hemoglobin A1C is:

A. Below 5.7%
B. Between 12%-15%
C. Less than 180 mg/dL
D. Between 90 and 130 mg/dL

18. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?

A. Alpha-glucosidase inhibitors
B. Biguanides
C. Meglitinides
D. Sulfonylureas

19. A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has Type I Diabetes Mellitus. Which of the follow actions should the nurse do first?

A. Inject 1 mg of glucagon subcutaneously.
B. Administer 50 mL of 50% glucose I.V.
C. Give 4 to 6 oz (118 to 177 mL) of orange juice.
D. Give the client four to six glucose tablets.

20. An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

A. is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals
B. gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal
C. continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels
D. is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream

21. Which of the following persons would most likely be diagnosed with Diabetes Mellitus? A 44-year-old:

A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.

22. 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

23. Anton brought his grandfather to the clinic to confirm his blood sugar levels. Which laboratory test should a nurse anticipate a physician would order when an older person is identified as high-risk for Diabetes Mellitus? 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. A patient received 6 units of regular insulin 3 hours ago. The nurse would be MOST concerned if which of the following was observed?

A. kussmaul respirations and diaphoresis
B. anorexia and lethargy
C. diaphoresis and trembling
D. headache and polyuria

25. Mr. Wesley is newly diagnosed with Type I DM and is being seen by the home health nurse. The doctors orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be

A. confused with cold, clammy skin and pulse of 110
B. lethargic with hot dry skin and rapid deep respirations
C. alert and cooperative with BP of 130/80 and respirations of 12
D. short of breath, with distended neck veins and bounding pulse of 96.

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: A. Try to limit simple sugars to between 10% and 20% of daily calories.

It is recommended that carbohydrates provide 50% to 60% of the daily calories. Approximately 40% to 50% should be from complex carbohydrates. The remaining 10% to 20 % of carbohydrates could be from simple sugars. Studies give no evidence that carbohydrates from simple sugars are digested and absorbed more rapidly that are complex carbohydrates, and they do not appear to affect blood sugar control.

2. Answer: D. acidosis

When a client’s carbohydrate consumption is inadequate, ketones are produced from the breakdown of fat. These ketones lower the pH of the blood, potentially causing acidosis that can lead to a diabetic coma.

3. Answer: C. Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals.

Eating small meals with two or three snacks may be more helpful in maintaining blood glucose levels than three large meals.

4. Answer: A. alcohol use.

Alcohol use is one of the most common risk factors for pancreatitis in the United States.

5. Answer: A, B, C, D

Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided. Weight gain should continue, but not in excessive amounts. Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after the pregnancy.

6. Answer: B. <130 mg/dl

The goal for pre-prandial blood glucose for those with Type 1 diabetes mellitus is <130 mg/dl.

7. Answer: B. Unlimited intake of total fat, saturated fat and cholesterol

The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus includes all of the following EXCEPT option B, unlimited intake of total fat, saturated fat and cholesterol.

8. Answer: B. Higher than 126 mg/dl

Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl.

9. Answer: B. An increase in three areas: thirst, intake of fluids, and hunger

The primary manifestations of diabetes type I are polyuria (increased urine output), polydipsia (increased thirst), polyphagia (increased hunger).

10. Answer: C. Lose a pound a week until weight is in normal range for height and exercise 30 minutes daily

When Type II diabetics lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents.

11. Answer: A. A client with an HDL cholesterol level of 40 mg/dl and a triglyceride level of 300 mg/dl

The seven risk criteria include: greater than 120% of standard body weight, Certain races but not including Caucasian, delivery of a baby weighing more than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired fasting glucose on prior testing.

12. Answer: D. 0.45% normal saline solution

0.45% normal saline solution is recommended.

13. Answer: C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development of hypoglycemia

Alcohol and/or aspirin taken with a sulfonylurea can cause development of hypoglycemia.

14. Answer: B. It has a higher mortality rate than Diabetic Ketoacidosis

HHNS occurs only in people with Type II Diabetes. It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. This condition develops very slowly over hours or days.

15. Answer: A. Pinch the skin up and use a 90 degree angle

The best angle for a thin person is 90 degrees with the skin pinched up. The area is not massaged and it is not necessary to warm it.

16. Answer: D. Smoking

Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.

17. Answer: A. Below 5.7%

A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the 2 to 3 months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

18. Answer: B. Biguanides

Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels

19. Answer: C. Give 4 to 6 oz (118 to 177 mL) of orange juice.

Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies such as Lifesavers, or 1 tablespoon of sugar. When a client has worsening symptoms of hypoglycemia or is unconscious, treatment includes 1 mg of glucagon subcutaneously or intramuscularly, or 50 mL of 50% glucose I.V. The nurse may also give two to three glucose tablets for a hypoglycemic reaction.

20. Answer: B. gives a small continuously dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dose from the pump before each meal

An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with an additional dose from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

21. 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.

22. 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.

23. Answer: A, B

When an older person is identified as high-risk for diabetes, appropriate testing would include FPG and OGTT. A FPG greater than 126 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: C. diaphoresis and trembling

Diaphoresis and trembling indicates hypoglycemia.

25. Answer: A. confused with cold, clammy skin and pulse of 110

Confused with cold, clammy skin and pulse of 110 indicate hypoglycemia.

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1 COMMENT

  1. hello regarding #12
    I think the correct answer is .9% Nacl (isotonic)
    .45% nacl(hypotonic) may too rapid and may have increased risk of cerebral edema.

    ”Most protocols call for an initial bolus of isotonic crystalloid solution (0.9% saline) at a starting rate of 15–20 mL/kg/h (1–1.5 L/h) for the first hour.3,8 Following the initial hydration, fluids can be administered at a decreased rate of 4–14 mL/kg/h. Tonicity of subsequent solution is dependent upon hydration status, electrolyte balance, and urine output. Rapid correction of serum sodium and, hence, serum osmolality by hypotonic fluids may carry an increased risk of cerebral edema.”

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