Chapter 15: Nutrition for Diabetes Mellitus My Nursing Test Banks

Chapter 15: Nutrition for Diabetes Mellitus

Grodner and Escott-Stump: Nutritional Foundations and Clinical Application: A Nursing Approach, 6th Edition

MULTIPLE CHOICE

1. At a routine physical examination, a 50-year-old man has a fasting blood glucose level of 160 mg/dL. The next step in diagnosis and treatment would be

a.

referral to a diabetes clinic.

b.

prescribing an oral hypoglycemic agent.

c.

rechecking fasting blood glucose level.

d.

evaluating cardiovascular risk factors.

ANS: C

Type 2 diabetes mellitus is diagnosed when the fasting blood glucose level exceeds 126 mg/dL on at least two occasions; therefore, the first step in care would be to recheck his fasting blood glucose level. If the diagnosis is confirmed, referral to a diabetes clinic, use of an oral hypoglycemic agent, and evaluation of cardiovascular risk factors may be warranted.

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2. If a patient with type 2 diabetes shows early signs of kidney disease, the first priority in nutrition management is

a.

restricting dietary protein intake.

b.

normalizing blood glucose levels.

c.

limiting dietary sodium intake.

d.

increasing fluid intake.

ANS: B

If a patient with diabetes begins to develop any kind of complications, the priority in treatment is always normalizing blood glucose levels. Avoiding excessive intakes of protein and sodium and maintaining adequate protein intake may be beneficial but are not the first steps.

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3. If a patient with type 1 diabetes is unable to maintain good blood glucose control through insulin injections, the physician may recommend

a.

an oral hypoglycemic agent.

b.

using an insulin pump.

c.

more frequent self-monitoring of blood glucose.

d.

a daily exercise routine.

ANS: B

An insulin pump is likely to result in better blood glucose management. Oral hypoglycemic agents cannot be used to treat type 1 diabetes. More frequent self-monitoring of blood glucose and daily exercise may be helpful but are not as beneficial as an insulin pump. A daily exercise routine has definite health benefits, especially for patients with diabetes, but it would not necessarily help normalize blood glucose level.

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4. If a 15-year-old student who runs cross-country and long-distance track events starts to lose weight and is continually thirsty and hungry, he or she may have

a.

type 1 diabetes.

b.

type 2 diabetes.

c.

acquired immunodeficiency syndrome (AIDS).

d.

hepatitis virus infection.

ANS: A

Polyphagia, polydipsia, and weight loss are hallmarks of untreated type 1 diabetes mellitus. Type 2 diabetes is associated with overweight and inactivity. AIDS and hepatitis may result in weight loss but are accompanied by loss of appetite rather than increased appetite.

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5. The cause of type 1 diabetes mellitus is

a.

excessive intake of simple sugars.

b.

destruction of pancreatic beta cells.

c.

inability of cells to respond to insulin in the bloodstream.

d.

inability of the pancreas to keep up with the bodys demands for insulin.

ANS: B

Type 1 diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells. Excessive sugar intake does not cause any kind of diabetes mellitus. Type 2 diabetes is caused by inability of cells to respond to insulin in the bloodstream. In type 1 diabetes, the pancreas is not able to keep up with the bodys demands for insulin, but the cause of this is destruction of beta cells.

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6. The two strongest risk factors for type 2 diabetes are

a.

obesity and family history.

b.

recurrent viral infections and stress.

c.

male gender and upper body obesity.

d.

preference for sweet foods and sedentary lifestyle.

ANS: A

The two strongest risk factors for type 2 diabetes are obesity and family history. Upper body obesity and sedentary lifestyle may also contribute to the risk for the disease. Male gender, preference for sweet foods, recurrent viral infections, and stress are not risk factors for type 2 diabetes.

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7. If a patient with type 2 diabetes wants to lose weight, the preferred choice of medication would be

a.

insulin.

b.

sulfonylureas.

c.

thiazolidinediones.

d.

metformin.

ANS: D

Metformin does not result in weight gain and may even result in weight loss because it decreases intestinal glucose absorption and improves insulin sensitivity. Insulin tends to cause weight gain because it lowers blood glucose levels by increasing storage as fat. Sulfonylureas tend to promote weight gain because they cause stimulate insulin secretion, and thiazolidinediones tend to promote weight gain because they cause improve insulin sensitivity.

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8. If members of an overweight family wants to reduce their risk for type 2 diabetes, the most helpful nutritional change they could make would be to

a.

increase their intake of dietary fiber.

b.

decrease their intake of refined sugar.

c.

decrease their portion sizes at meals and snacks.

d.

switch to a vegetarian pattern of eating.

ANS: C

The best way to prevent development of type 2 diabetes is to attain a normal body weight; decreasing portion sizes would help decrease energy intake, resulting in weight loss. Increasing intake of dietary fiber would be of some benefit in increasing satiety; high-fiber foods generally tend to be lower in fat and energy, and so increasing their intake may be of some benefit, but it is possible to increase fiber intake without decreasing energy intake. High sugar intake does not cause type 2 diabetes, unless it causes weight gain. Switching to a vegetarian pattern of eating may not be beneficial and could even cause further weight gain if the diet includes a lot of eggs and cheese; a vegan eating pattern would probably help with weight loss and decrease risk for type 2 diabetes.

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9. In a patient with type 2 diabetes, a glycosylated hemoglobin (HgbA1c) level of 7.9% would be considered

a.

too low.

b.

normal.

c.

indicative of prediabetes.

d.

indicative of poor blood glucose control.

ANS: D

For individuals with type 2 diabetes mellitus, glycosylated hemoglobin levels should be less than 7%; 7.9% indicates poor blood glucose control. Prediabetes would be diagnosed if a previously undiagnosed client had an HgbA1c level of 5.7% to 6.4%. A too low level of HgbA1c has not been identified.

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10. The person who would be most likely to develop type 2 diabetes mellitus is a(n)

a.

sedentary Asian American man.

b.

man with alcohol-related cirrhosis of the liver.

c.

woman with retinal damage.

d.

overweight Native American woman.

ANS: D

The prevalence of type 2 diabetes mellitus is high among Native Americans, and risk increases with overweight. The prevalence of type 2 diabetes among Asian Americans is relatively low, even though being sedentary contributes to risk. Retinal damage may be a complication of the disease, but it does not increase risk of developing it. Alcohol abuse and cirrhosis of the liver do not contribute to risk for type 2 diabetes.

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11. If someone using intensive insulin therapy with multiple injections daily wanted to celebrate his or her birthday and enjoy a slice of birthday cake, he or she would

a.

decrease food intake at other meals.

b.

add an extra aerobic workout afterwards.

c.

use an extra dose of intermediate- or long-acting insulin.

d.

use an extra dose of short- or rapid-acting insulin.

ANS: D

Intensive insulin therapy allows for unexpected meals and snacks by adding a dose of short- or rapid-acting insulin. Intermediate- or long-acting insulin would not act quickly enough to normalize blood glucose levels. An extra aerobic workout may help decrease blood glucose levels, but it could produce dangerous ketosis if blood glucose levels are too high. The patient may choose to slightly decrease food intake at other meals to offset the extra energy intake, but any major decrease in food intake at other meals could cause hypoglycemia, and eating the cake afterwards would cause hyperglycemia.

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12. If a patient with diabetes mellitus checks blood glucose level before going for a 2-mile run and it is 90 mg/dL, he or she should

a.

administer extra short- or rapid-acting insulin.

b.

administer extra intermediate- or long-acting insulin.

c.

eat carbohydrate-containing food before exercising.

d.

go for the run and recheck blood glucose levels afterwards.

ANS: C

Patients with diabetes mellitus should exercise when their blood glucose level is between 100 and 250 mg/dL. With a blood glucose level of 90 mg/dL, the patient may experience hypoglycemia during the run, so he or she should first eat food containing carbohydrate. Administering extra insulin of any type would lower blood glucose levels still further and cause dangerous hypoglycemia.

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13. To prevent hypoglycemia after exercise, patients with type 1 diabetes should

a.

decrease the insulin dose.

b.

omit a scheduled insulin dose.

c.

increase their intake of protein-based foods.

d.

increase their intake of carbohydrate-based foods.

ANS: D

To prevent hypoglycemia after exercise, patients with type 1 diabetes should increase their intake of carbohydrate-based foods. Decreasing or omitting an insulin dose would essentially starve cells and could be dangerous. Increasing intake of protein-based foods would not prevent a decrease in blood glucose level as effectively as would carbohydrate-based foods.

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14. The best strategy for a patient with type 2 diabetes to use to maintain good metabolic control is to

a.

avoid all sources of simple carbohydrates.

b.

avoid eating during the evening or at night.

c.

space their meals evenly throughout the day.

d.

eat one large meal and two small meals each day.

ANS: C

Patients with type 2 diabetes are most likely to maintain good metabolic control if they space their meals evenly throughout the day. Avoiding all sources of simple carbohydrates does not address other dietary excesses of kilocalories, fat, and complex carbohydrate. Avoiding eating during the evening and at night may help control kilocalorie intake but would not help control blood glucose levels. Eating one large meal and two small meals each day would result in uneven metabolic control.

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15. Glycosylated hemoglobin level is used to indicate

a.

the effect of meals on blood glucose level.

b.

day-to-day variations in blood glucose level.

c.

iron deficiency anemia in patients with diabetes.

d.

overall blood glucose control over several weeks.

ANS: D

Glycosylated hemoglobin level is used to indicate overall blood glucose control throughout the previous 100 to 120 days. The effect of meals on blood glucose level is determined through self-monitoring of blood glucose levels. Glycosylated hemoglobin level does not show day-to-day variations in blood glucose level. Iron deficiency anemia is diagnosed through measurement of total hemoglobin level in patients with and without diabetes.

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16. A young man with type 1 diabetes runs 3 miles, falls asleep on the sofa, and forgets to eat his next meal. He is likely to experience

a.

nephropathy.

b.

hypoglycemia.

c.

hyperglycemia.

d.

diabetic ketoacidosis.

ANS: B

A young man who exercises and forgets to eat his next meal is likely to experience hypoglycemia because he used up his available blood glucose and glycogen stores while exercising but still has exogenous insulin in his bloodstream. Hyperglycemia would occur if he ate extra carbohydrate without using extra insulin. Diabetic ketoacidosis would occur if he omitted insulin doses. Nephropathy is a long-term complication of diabetes mellitus.

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17. An individual with a blood glucose level of 40 mg/dL would have

a.

hypoglycemia.

b.

a normal blood glucose level.

c.

hyperglycemia.

d.

impaired glucose tolerance.

ANS: A

The normal range of blood glucose levels is 90 to 130 mg/dL; therefore, 40 mg/dL represents hypoglycemia. Blood glucose levels above 180 mg/dL would represent hyperglycemia. Impaired glucose tolerance is diagnosed when fasting plasma glucose levels are 100 to 125 mg/dL.

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18. Diabetic ketoacidosis may occur in a patient with type 1 diabetes who

a.

gets caught in traffic and misses a meal.

b.

participates in an all-day sporting event.

c.

accidentally takes a double dose of insulin.

d.

goes away for the weekend and forgets to take his or her insulin.

ANS: D

Diabetic ketoacidosis may occur in a patient with type 1 diabetes who goes away for the weekend and forgets to take his or her insulin. Missing a meal would cause hypoglycemia. Participation in an all-day sporting event could cause hypoglycemia if he or she did not eat extra food. Taking a double dose of insulin would cause hypoglycemia.

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19. If a woman is brought into the emergency room with nausea, weakness, and fruity-smelling breath, the test you would perform first is

a.

blood glucose measurement.

b.

blood alcohol measurement.

c.

a pregnancy test.

d.

blood pressure measurement.

ANS: A

The most important test to perform first is measurement of blood glucose level because this can and must be corrected rapidly if the patient has ketoacidosis. Blood alcohol level could be checked if blood glucose level is normal. A pregnancy test and blood pressure may be important measurements if blood glucose and blood alcohol are normal, but those would not be performed first.

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20. If someone with type 1 diabetes has nausea and vomiting, weakness, and fatigue, as well as excessive hunger and thirst, but does not have a fruity or acetone odor on his or her breath, he or she may have

a.

hepatic encephalopathy.

b.

diabetic ketoacidosis.

c.

hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

d.

hypoglycemia.

ANS: C

Nausea and vomiting, weakness, fatigue, polyphagia, and polydipsia can all be symptoms of both HHNS and diabetic ketoacidosis. However, with diabetic ketoacidosis, the breath smells fruity because of ketones. If this is not the case, the patient has HHNS. Hypoglycemia would be characterized by hunger, confusion, trembling, and erratic behavior. Hepatic encephalopathy is not associated with diabetes.

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21. If a young man with type 1 diabetes wants to eat cake for dessert after a meal of roast chicken, mashed potatoes, gravy, green beans, and dinner rolls, he should eat

a.

fewer potatoes, fewer rolls, or fewer of both.

b.

less chicken and gravy.

c.

fewer green beans.

d.

less of everything.

ANS: A

Foods containing sucrose (such as cake or other desserts) should be substituted for other carbohydrate foods in the meal plan, and so he should eat fewer potatoes or rolls. Chicken, gravy, and green beans have low levels of carbohydrate, and so he does not need to eat less if he wants to eat dessert.

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22. Patients with type 1 diabetes should be taught to regulate the _____ in meals and snacks.

a.

kilocalorie content

b.

total amount of sugars

c.

total amount of dietary fiber

d.

total amount of carbohydrates

ANS: D

Patients with type 1 diabetes should learn to regulate the total amount of carbohydrates in meals and snacks. The overall kilocalorie content and amount of dietary fiber are less important. The amount of sugar is important only as it contributes to total carbohydrate.

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23. An example of a good after-workout snack for someone with type 1 diabetes is

a.

skim milk.

b.

beef jerky.

c.

string cheese.

d.

peanuts.

ANS: A

A good after-workout snack for someone with type 1 diabetes is a glass of milk. Milk provides carbohydrate in the form of lactose. Beef jerky and string cheese do not provide carbohydrate. Peanuts provide some carbohydrate but not enough to restore blood glucose levels after a workout.

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24. If a patient with diabetes complains that he or she is experiencing diarrhea on a regular basis, the nurse should ask about

a.

whether the patient uses sugar-free gum.

b.

the patients intake of dietary fiber.

c.

the amount of sleep that the patient gets each night.

d.

the patients use of laxative medications.

ANS: A

Sugar-free gum is sweetened with sugar alcohols, sorbitol, mannitol, and xylitol, which may cause diarrhea when used in large amounts. Low intake of dietary fiber may cause constipation, but high intake does not usually cause diarrhea. Amount of sleep does not usually affect bowel function significantly. The nurse may ask about use of laxative medications, but it is unlikely that a patient who complains about diarrhea is using them.

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25. Patients with diabetes are most likely to maintain good glycemic control successfully if their prescribed meal plan

a.

includes some favorite foods each week.

b.

is based on the patients usual eating habits.

c.

is tailored to achieve individual weight-loss goals.

d.

include meals and snacks eaten at the same time each day.

ANS: B

To facilitate compliance, patients meal plans should be based on their usual eating habits. Including some favorite foods each week may improve quality of life, achieving weight-loss goals may minimize the effects of the disease, and including meals and snacks at the same time each day may improve glycemic control, but these measures would not have much effect on compliance.

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26. If a young woman with type 1 diabetes mellitus is in a car accident and breaks several bones, she is likely to need

a.

less insulin than usual.

b.

more insulin than usual.

c.

a different type of insulin.

d.

the same amount of insulin.

ANS: B

Serious injury increases insulin requirements because of increased hepatic glucose production caused by the release of epinephrine, norepinephrine, glucagon, and cortisol.

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27. If a patient with type 1 diabetes mellitus has a fever and no appetite, he or she should consume

a.

dry foods, such as toast or crackers.

b.

commercial liquid nutrition supplements.

c.

liquid or soft sources of carbohydrates.

d.

water, tea, or beverages sweetened with nonnutritive sweeteners.

ANS: C

Patients with type 1 diabetes mellitus who are sick and unable to eat regular food should consume liquid or soft sources of carbohydrates to maintain their blood glucose level. Dry foods may be difficult to eat and would not help restore fluid losses caused by fever. Commercial liquid nutrition supplements are expensive and unnecessary. Noncaloric fluids would prevent dehydration but would not provide carbohydrate to maintain the blood glucose level.

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28. Eating plans for patients with diabetes mellitus and gastroparesis should include

a.

six small meals daily.

b.

three regular meals daily.

c.

high-protein intake.

d.

increased fluid intake.

ANS: A

For patients with gastroparesis, six small meals daily are better tolerated than three regular meals daily. Patients with gastroparesis do not have increased needs for protein and fluid.

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29. A pregnant woman is most likely to develop gestational diabetes during her pregnancy if she

a.

is underweight and gains insufficient weight during pregnancy.

b.

is overweight and has a family history of type 2 diabetes.

c.

has cravings for high-sugar foods during the first trimester.

d.

is white, non-Hispanic, and unmarried.

ANS: B

Gestational diabetes is associated with overweight and family history of type 2 diabetes. Underweight and insufficient weight gain may cause intrauterine growth retardation. Sugar intake and food cravings do not directly affect risk of gestational diabetes. White, non-Hispanic women have a lower risk for gestational diabetes than do Native American, African American, and Hispanic and Latina American women. Marital status is not associated with risk for gestational diabetes.

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30. For women with type 1 diabetes, good metabolic control is especially important at the time of conception and during the first trimester to prevent

a.

macrosomia.

b.

fetal malformations.

c.

nutrient deficiencies.

d.

excessive weight gain.

ANS: B

In women with type 1 diabetes, good metabolic control at the time of conception and during the first trimester helps prevent fetal malformations. Macrosomia is related to hyperglycemia in the second and third trimesters. Metabolic control does not affect nutrient deficiencies. Excessive weight gain may exacerbate poor metabolic control, but poor metabolic control does not usually cause weight gain.

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