Chapter 47 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 47

Question 1

Type: MCSA

The nurse is caring for a patient with a diagnosis of diabetes. The nurse notes the patients toenails are thick and ingrown. Which instruction should the nurse provide?

1. Soak feet in Epsom salts daily.

2. Use a clean, sharp razor blade to trim the toenails.

3. Make an appointment with a foot care specialist.

4. Trim nails to follow the curve of the toe.

Correct Answer: 3

Rationale 1: Soaking of the feet is not advisable.

Rationale 2: Sharp instruments or razor blades should never be used to self-treat foot problems.

Rationale 3: The toenails of the patient with diabetes require careful attention. Problems should be addressed by a foot care specialist.

Rationale 4: Nails should be cut straight across and the edges filed, not cut.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-5

Question 2

Type: MCSA

A diabetic patient complains of frequent corns and asks for information about managing the condition. What is the nurses best response?

1. Make sure you select shoes that fit correctly.

2. You can use corn pads to gradually remove the growths.

3. Corns are best treated by shaving them off.

4. Apply a generous amount of emollient lotion on and between the toes twice daily.

Correct Answer: 1

Rationale 1: Corns can be prevented by wearing correctly fitting shoes.

Rationale 2: Corn pads are not an option for the diabetic patient.

Rationale 3: Shaving treatments to remove corns are not an option for the diabetic patient.

Rationale 4: Lotion can be applied if the skin is dry, but the area between the toes should be avoided.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-5

Question 3

Type: MCSA

A patient has been recently diagnosed with type 1 diabetes mellitus. The patient states, I am thin and eat all the time. How can I have diabetes? Which response by the nurse is most appropriate?

1. Thin people can be diabetic, too.

2. Your condition makes it impossible for you to gain weight.

3. People with type 1 diabetes are usually thin or of normal weight at diagnosis.

4. Your lab tests indicate the presence of diabetes.

Correct Answer: 3

Rationale 1: Although this statement is correct, it does not answer the patients question.

Rationale 2: It is not impossible for diabetics to gain weight.

Rationale 3: The diabetic patient is unable to obtain the needed glucose for the bodys cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin.

Rationale 4: Although the laboratory tests might indicate the presence of diabetes, this response does not meet the patients need for teaching.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-2

Question 4

Type: MCSA

A newly admitted patient has a fasting serum blood glucose level of 125 mg/dL. How should the nurse interpret this value?

1. This is a critical value that should be reported immediately.

2. The patient has type 1 diabetes.

3. The patient has normal glucose metabolism.

4. The patient may be prediabetic.

Correct Answer: 4

Rationale 1: While the physician will need to be made aware of these results, there is no indication the physician needs to be contacted immediately.

Rationale 2: A single serum glucose level is not sufficient for either a diagnosis of diabetes or a determination of type of diabetes.

Rationale 3: These results are not normal.

Rationale 4: Prediabetes is defined as a fasting serum glucose value of 100126 mg/dL. The diagnosis is made on glucose of this level drawn on two or more occasions.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-2

Question 5

Type: MCSA

A patient recently diagnosed with diabetes states, A friend whose mother was diabetic told me that it is more economical to use urine dipsticks than to monitor blood levels with a glucometer. Which response by the nurse is most appropriate?

1. Urinary glucose is no longer used to routinely monitor glucose control.

2. You will be monitoring your urine glucose as well as your blood glucose.

3. Yes, urine dipsticks are cheaper than glucose test strips.

4. Would you like to switch to this method of monitoring?

Correct Answer: 1

Rationale 1: Self-monitoring of blood glucose has replaced urinary measurement.

Rationale 2: The patient will likely monitor only blood glucose.

Rationale 3: This response does not provide adequate information.

Rationale 4: The nurse should not suggest that the patient change to an outmoded method of glucose testing.

Global Rationale: 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-5

Question 6

Type: MCSA

Genetic testing indicates that a child has DR3 and DR4 antigens on chromosome 6 of the human leukocyte antigen system. Which statement by the parents would indicate the nurse should reinforce teaching about these test results?

1. Our son has a genetic immunity disorder.

2. These results mean our son has diabetes.

3. These markers are present in 95% of people with type 1 diabetes.

4. These results are associated with increased susceptibility to diabetes.

Correct Answer: 1,2

Rationale 1: These results are not specific for disorders of immunity.

Rationale 2: These results are not diagnostic of diabetes but do indicate increased risk.

Rationale 3: Genetic markers that determine immune responses, specifically DR3 and DR4 antigens on chromosome 6 of the human leukocyte antigen (HLA) system, have been found in 95% of people diagnosed with type 1 diabetes.

Rationale 4: The results do indicate increased susceptibility.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 47-1

Question 7

Type: MCSA

A nurse manager is observing a staff nurse providing teaching to a 5-year-old patient who has a diagnosis of type 1 diabetes mellitus. The manager evaluates that instruction is appropriate when the nurse makes which analogy to explain the action of insulin?

1. Insulin is like a building block that helps make protein into strong muscles.

2. Insulin is like a wagon that carries sugar into the cells of the body.

3. Insulin is like a mud pie that makes the blood vessels thick and sticky.

4. Insulin is like salty potato chips that make people feel very thirsty.

Correct Answer: 2

Rationale 1: Insulin does not make protein into muscle.

Rationale 2: The manifestations of type 1 DM are the result of a lack of insulin to transport glucose across the cell membrane into the cells. The analogy of the wagon carrying sugar into the cells is appropriate for teaching a 5-year-old child about insulin therapy.

Rationale 3: Insulin does not make blood vessels thick and sticky.

Rationale 4: A scarcity of insulin may lead to polydipsia.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 47-2

Question 8

Type: MCMA

The nurse is caring for a healthy patient who has a serum glucose level of 60 mg/dL. The nurse anticipates that which counterregulatory serum hormonal changes are likely to occur in this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Increased epinephrine levels

2. Increased growth hormone levels

3. Increased insulin levels

4. Decreased glucagon levels

5. Decreased cortisol levels

Correct Answer: 1,2

Rationale 1: Epinephrine is associated with glycogenolysis, gluconeogenesis, and lipolysis.

Rationale 2: Growth hormone causes lipolysis and provides precursors for gluconeogenesis and ketogenesis.

Rationale 3: Insulin is not a counterregulatory hormone. It functions to decrease serum glucose.

Rationale 4: The primary functions of glucagon include hepatic gluconeogenesis, glycogenolysis, lipolysis, and ketogenesis. Levels of glucagon increase with decreased serum glucose.

Rationale 5: Cortisol causes protein catabolism and lipolysis. Cortisol levels increase when serum glucose levels drop.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-2

Question 9

Type: MCSA

The nurse is caring for a patient who has a diagnosis of diabetes mellitus type 1. Which finding would best indicate that the patient is at risk for developing diabetic ketoacidosis?

1. Reports of anxiety

2. Tremors

3. Nausea and vomiting

4. Extreme hunger

Correct Answer: 3

Rationale 1: Anxiety is more often associated with hypoglycemia.

Rationale 2: Tremors are associated with hypoglycemia.

Rationale 3: Nausea and vomiting are thought to result from the accumulation of serum ketones.

Rationale 4: Extreme hunger is associated with hypoglycemia.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-6

Question 10

Type: MCSA

The nurse is assessing a patient who has a family history of type 2 diabetes. Which finding would require follow-up by the nurse?

1. The patient reports having a new prescription for a thiazide diuretic for blood pressure control.

2. Measurements indicate the patient has decreased the waist-to-hip ratio through dietary changes.

3. The patient delivered a baby that weighed 8 pounds and 12 ounces.

4. The patients fasting blood glucose level is 95 mg/dL.

Correct Answer: 1

Rationale 1: Some medications, including thiazide diuretics, may increase the risk for type 2 diabetes, especially in patients with other risk factors.

Rationale 2: This is a desired finding.

Rationale 3: Delivering a baby that weighs over 9 pounds increases the risk for developing type 2 diabetes.

Rationale 4: This is a desirable level for blood glucose.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 47-1

Question 11

Type: MCSA

The nurse recognizes that which factor in a patients history increases the risk for type 2 diabetes mellitus (DM)?

1. Body mass index of 23

2. Blood pressure of 130/80

3. Physical inactivity

4. Low waist-to-hip ratio

Correct Answer: 3

Rationale 1: Having a body mass index over 25 increases the risk of developing type 2 DM.

Rationale 2: Blood pressure of 140/90 mmHg or above places the patient at risk for type 2 DM.

Rationale 3: Physical inactivity is a major risk factor for type 2 DM.

Rationale 4: A high waist-to-hip ratio is a risk factor for type 2 DM.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-1

Question 12

Type: MCSA

Which teaching, included in the plan of care for a patient who has type 1 diabetes mellitus, would be most effective in reducing the development of complications?

1. Self-monitoring of blood glucose levels

2. Effective foot care

3. Importance of early eye exam

4. Avoidance of simple carbohydrates in the diet

Correct Answer: 1

Rationale 1: Frequent monitoring of blood glucose levels facilitates necessary adjustments in diet, physical activity, and pharmacologic therapy.

Rationale 2: Effective foot care is an important risk reduction strategy but is not the most effective way to prevent the most complications.

Rationale 3: The patient with diabetes should have a yearly eye exam, but this is not the most effective way to prevent the most complications.

Rationale 4: The patient with diabetes should reduce the intake of simple carbohydrates, but this is not the most effective way to prevent the most complications.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 47-5

Question 13

Type: MCSA

The nurse is caring for a patient with no history of diabetes who has a new laboratory finding of a glycosylated hemoglobin (A1C) level of 6.0%. Which nursing diagnoses should receive priority for this patient?

1. Deficient Knowledge regarding disease process

2. Risk for Deficient Fluid Volume

3. Risk for Impaired Skin Integrity

4. Ineffective Tissue Perfusion

Correct Answer: 1

Rationale 1: The normal range of hemoglobin A1C is 2% to 5% for a nondiabetic. This patients level is elevated, so the patient may have prediabetes or diabetes. The nurses priority is to ensure the patient obtains the information necessary to make healthful lifestyle choices.

Rationale 2: Changes in hemoglobin A1C levels are not associated with fluid volume changes.

Rationale 3: If the patient is diabetic, there is a risk for impairment of skin integrity. However, this is not the priority diagnosis.

Rationale 4: Ineffective Tissue Perfusion may occur in patients who are diabetic. There is no indication that this change has occurred in this patient. Prioritization would depend on symptomology.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 47-5

Question 14

Type: MCMA

The nurse is evaluating the effectiveness of teaching in a patient with a diagnosis of diabetes mellitus type 2 who is learning to self-monitor blood glucose. The nurse knows teaching has been effective when the patient identifies which factors that may adversely affect glucose meter performance?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The age of the monitor strip

2. Failure to follow manufacturers recommendations regarding cleaning of meter

3. The lot number of the strips

4. Use of soap and water to cleanse the finger before puncture

5. Insufficient amount of blood on the meter strip

Correct Answer: 1,2,3,5

Rationale 1: Monitor strips have expiration dates to ensure accuracy.

Rationale 2: Many factors may affect glucose meter performance, including failure to follow the manufacturers recommendations regarding meter cleaning.

Rationale 3: Many meters must be calibrated to the correct lot number of the strips.

Rationale 4: The skin should be cleansed and dried before puncture. Washing with soap and water is an acceptable cleansing routine.

Rationale 5: Many factors may affect glucose meter performance, including insufficient amounts of blood on the meter strip.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 47-5

Question 15

Type: MCSA

The nurse is preparing patients newly diagnosed with diabetes mellitus (DM) for discharge from an acute care facility. What should the nurse include in patient teaching regarding medications to treat DM?

1. Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications.

2. Type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled.

3. Patients with type 1 diabetes will always need an exogenous source of insulin.

4. Patients with type 2 diabetes generally need a combination of oral medications and insulin to achieve normal blood glucose levels.

Correct Answer: 3

Rationale 1: People with type 1 DM must have insulin.

Rationale 2: Patients with diabetes do not progress from type 1 to type 2.

Rationale 3: The person with type 1 DM requires a lifelong exogenous source of insulin to maintain life.

Rationale 4: Patients with type 2 DM are usually able to control glucose levels with an oral hypoglycemic medication, but they may require insulin if control is inadequate.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 47-3

Question 16

Type: MCMA

The nurse is identifying patient demographic groups that are at increased risk for needing insulin to control blood sugar. Which patient groups would the nurse identify?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Patients who are fasting or malnourished

2. Patients with type 2 diabetes who are diagnosed with an infection

3. Patients with type 2 diabetes who are undergoing surgical procedures

4. Patients with gestational diabetes

5. Patients receiving total parenteral nutrition

Correct Answer: 2,3,4,5

Rationale 1: Fasting and malnourished patients are more likely to be hypoglycemic.

Rationale 2: Stressors such as infection may cause hyperglycemic reactions in persons with type 2 diabetes. Temporary use of insulin may be indicated.

Rationale 3: Stressors such as surgery may cause hyperglycemic reactions in persons with type 2 diabetes. Temporary use of insulin may be indicated.

Rationale 4: Patients with gestational diabetes may require insulin therapy.

Rationale 5: People who are receiving high-calorie tube feedings or parenteral nutrition will likely require insulin for blood glucose control.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-3

Question 17

Type: MCSA

Which of these statements by a patient who has a new diagnosis of diabetes mellitus requires immediate nursing intervention?

1. I am allergic to eggs.

2. I will take my lispro insulin 15 minutes before I eat breakfast.

3. I will adjust the amounts of my premixed insulin according to my food intake.

4. I will not use detemir insulin in my insulin pump.

Correct Answer: 3

Rationale 1: An allergy to eggs does not require immediate nursing intervention.

Rationale 2: Lispro insulin is properly administered 15 minutes prior to a meal.

Rationale 3: One of the problems associated with premixed insulin is that it does not allow easy adjustment of premeal and basal insulin.

Rationale 4: Detemir insulin is not used in insulin pumps.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-3

Question 18

Type: MCMA

A patient diagnosed with type 2 diabetes is prescribed the second-generation sulfonylurea glipizide. What medication information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It is best to take this medication at bedtime.

2. Give us a call if you begin to gain weight.

3. If you drink alcohol while taking this medication, you will probably feel very sick.

4. Because you are taking this medication, dietary control of your disease is not as important.

5. Be watchful for any swelling in your ankles.

Correct Answer: 2,3

Rationale 1: Glypizide should be taken 30 minutes before meals.

Rationale 2: Weight gain is a possible adverse effect of glypizide. The amount of weight gained should be monitored.

Rationale 3: A possible disulfiram reaction may occur if the patient drinks alcohol while taking glypizide.

Rationale 4: Dietary controls are still an important part of disease management even when medications are being taken.

Rationale 5: Ankle edema is not a common reaction to glypizide.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-3

Question 19

Type: MCSA

A patient who has a diagnosis of diabetes mellitus says, I am worried because my feet are swollen. You dont think my diabetes is getting worse, do you? The nurse identifies that the patient is hypertensive and has albuminuria. These findings would help substantiate which priority nursing diagnosis?

1. Excess Fluid Volume related to compromised regulatory mechanisms

2. Anxiety related to illness

3. Risk for Infection related to chronic disease process

4. Ineffective Denial related to minimization of symptoms

Correct Answer: 1

Rationale 1: Diabetic nephropathy is a disease of the kidneys characterized by the presence of albumin in the urine, hypertension, edema, and progressive renal insufficiency.

Rationale 2: The patient does admit being worried, but anxiety is not the priority NDX.

Rationale 3: Infection may complicate diabetes management and can be implicated in kidney disease, but there are no strong indicators of infection in this scenario.

Rationale 4: There is some evidence of ineffective denial in this scenario, but this is not the priority NDX.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 47-5

Question 20

Type: MCSA

A patient who has diabetes mellitus says to the nurse, Ive had difficulty swallowing and have felt nauseous for months. I have been taking milk of magnesia every day for constipation, too. The nurse should recognize these statements as likely being indicative of which condition?

1. The aging process

2. Autonomic neuropathy

3. Retinopathy

4. Nephropathy

Correct Answer: 2

Rationale 1: Difficulty swallowing and nausea are not specifically attributable to aging.

Rationale 2: Gastrointestinal dysfunction caused by autonomic neuropathy causes changes in upper gastrointestinal motility (gastroparesis) resulting in dysphagia, anorexia, heartburn, nausea, vomiting, and altered blood glucose control. Constipation is one of the most common gastrointestinal manifestations associated with DM, possibly a result of hypomotility of the bowel.

Rationale 3: Nausea and difficulty swallowing are not symptoms of retinopathy.

Rationale 4: Nausea and difficulty swallowing are not symptoms of nephropathy.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-5

Question 21

Type: MCMA

The nurse is assessing a patient who has a diagnosis of diabetes mellitus. Which questions would be most important to help determine the patients risk for amputation of a lower extremity?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Do you use insulin or oral hypoglycemic agents?

2. What were your glycosylated hemoglobin values over the past year?

3. Do you have any problems with your eyes related to diabetes?

4. Do you have any problems with your kidneys related to diabetes?

5. When were you first diagnosed with diabetes mellitus?

Correct Answer: 2,3,4,5

Rationale 1: The treatment of the diabetes is not a risk factor.

Rationale 2: Poor glucose control is a risk factor for lower extremity ulcers and amputation.

Rationale 3: Patients with retinal complications of diabetes have a higher risk for lower extremity amputation.

Rationale 4: Patients with renal complications of diabetes have a higher risk for lower extremity amputation.

Rationale 5: Patients diagnosed with DM for over 10 years are at higher risk for lower extremity amputation.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-5

Question 22

Type: MCSA

The nurse reads these notes in the health care record of a patient who has a diagnosis of diabetes and a nursing diagnosis of Altered Skin Integrity. Which outcome would be most appropriate for the nurse to establish with this patient?

1. The patient will bring a caregiver to the next health care appointment.

2. The patient will describe the steps of effective diabetic foot care.

3. The patient will explain why patients with diabetes should not go barefoot.

4. The patient will report obtaining a thermometer for monitoring bath water temperature.

Correct Answer: 1

Rationale 1: Foot care is a priority in DM management. If the person has visual deficits, is obese, or cannot reach the feet, the caregiver must be taught how to inspect and care for the feet. Feet should be inspected daily.

Rationale 2: Even if the patient can describe the steps of effective foot care, obesity and the inability to see will make it difficult to perform these steps independently.

Rationale 3: It would be very beneficial for the patient to understand this concept, but another outcome goal is more important.

Rationale 4: It is important to prevent scalding injuries, but it is unlikely that this patient can read a thermometer independently.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 47-5

Question 23

Type: MCSA

The nurse is providing instruction to a group of patients who are planning to participate in an athletic triathlon. Each member of the group has been diagnosed with either diabetes mellitus type 1 or type 2. A member of the group asks, If we each follow our usual daily diabetic control routine, which diabetic complication is most likely to occur during this event? What is the nurses best answer?

1. Diabetic ketoacidosis

2. Hypoglycemia

3. Hyperosmolar hyperglycemic state

4. Impaired glucose tolerance

Correct Answer: 2

Rationale 1: Diabetic ketoacidosis is related to deficiency in insulin secretion with extremely high blood glucose levels. It is not associated with exercise.

Rationale 2: Severe hypoglycemia often results from too much insulin, too little food, or too much exercise.

Rationale 3: Hyperosmolar hyperglycemic state results from dehydration, but it is generally limited to those who cannot obtain fluids, are neglected or institutionalized, or have mental deficiencies.

Rationale 4: Impaired glucose tolerance is the state of prediabetes and is not associated with exercise.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-6

Question 24

Type: MCSA

The nurse is addressing a group of patients with prediabetes. What should the nurse include in a teaching plan for this group?

1. The person with prediabetes needs insulin to maintain normal blood glucose levels.

2. Patients with prediabetes are at increased risk for macular degeneration.

3. Individuals with prediabetes should limit fluid intake.

4. The person with prediabetes has an increased risk of heart disease.

Correct Answer: 4

Rationale 1: A patient with prediabetes may not always develop diabetes, and not all diabetics require insulin.

Rationale 2: The risk of macular degeneration does not increase with prediabetes diagnosis.

Rationale 3: Fluids are not restricted in prediabetes.

Rationale 4: The individual with prediabetes is at risk for cardiovascular disease.

Global Rationale: 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-2

Question 25

Type: MCSA

The nurse is planning a presentation to a community group on diabetes mellitus. The nurse should include information about which possible etiology for type 1 diabetes?

1. Inflammatory disorder

2. Infectious disorder

3. Autoimmune disorder

4. Drug-induced disorder

Correct Answer: 3

Rationale 1: There is no indication that type 1 diabetes is caused by inflammation.

Rationale 2: It is believed by some that type 1 diabetes may be caused by an event, such as an infection, that triggers an autoimmune response. But the disease is not strictly an infectious disorder and is not communicable. Characterizing diabetes as infectious may cause undue concern among laypersons.

Rationale 3: Type 1 diabetes, formerly called insulin-dependent or juvenile diabetes, is caused by an autoimmune process.

Rationale 4: Diabetes is not caused by drugs.

Global Rationale: 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-2

Question 26

Type: MCSA

Which information should the nurse include when teaching a patient about fasting blood glucose level testing?

1. Your test is scheduled for 6:00 a.m., so do not eat or drink anything after midnight.

2. After the sample is drawn you will be asked to drink a sweet liquid.

3. This test will indicate your average blood sugar over the last 2 months.

4. The fasting glucose must be 100 or under to be normal.

Correct Answer: 4

Rationale 1: Fasting blood glucose testing requires fasting for at least 10 hours before the sample is drawn.

Rationale 2: Drinking a sweet liquid is required for a glucose tolerance test.

Rationale 3: Hemoglobin A1C indicates average blood sugar over the last 1 to 3 months.

Rationale 4: The normal value for fasting glucose is 60 to 100 mg/dL.

Global Rationale: 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 47-5

Question 27

Type: MCSA

At a community health screening for blood glucose testing, the nurse would expect which person to have the highest risk for having type 2 diabetes?

1. A 30-year-old Caucasian patient who recently had a baby

2. A patient who lives in a nearby rural farming town

3. A patient following a high-protein diet

4. A 40-year-old with weight centered in the abdomen

Correct Answer: 4

Rationale 1: Postpartum status does not appear to be a risk factor for type 2 diabetes.

Rationale 2: Individuals living in urban areas, perhaps due to more sedentary lifestyles, may be at higher risk for type 2 diabetes.

Rationale 3: Consuming a high-protein diet does not appear to be a risk factor for type 2 diabetes.

Rationale 4: The risk factors for type 2 diabetes include obesity, especially apple shape or abdominal obesity.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-1

Question 28

Type: MCMA

Admission assessment reveals these patient findings. The nurse would consider which results as indicating metabolic syndrome education should be provided?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Female gender, waist circumference of 78.5 cm

2. Swelling of thighs and lower extremities

3. Blood pressure 166/84

4. Triglyceride levels 325 mg/dL

5. Fasting glucose of 110 mg/dL

Correct Answer: 3,4,5

Rationale 1: One of the criteria for a diagnosis of metabolic syndrome in women is an abdominal circumference of 88 cm or more.

Rationale 2: Swelling of the lower extremities may be associated with poor venous return, CHF, hypoalbuminemia, or other disorders but is not one of the criteria for metabolic syndrome.

Rationale 3: One of the criteria for a diagnosis of metabolic syndrome is blood pressure >135/85.

Rationale 4: One of the criteria for a diagnosis of metabolic syndrome is a triglyceride level equal to or over 150 mg/dL.

Rationale 5: One of the criteria for a diagnosis of metabolic syndrome is a fasting glucose level equal to or over 100 mg/dL.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-1

Question 29

Type: MCSA

The nurse is teaching a patient with newly diagnosed type 1 diabetes about the required diet for managing the disorder. Which information should the nurse include?

1. Do not consume alcoholic beverages.

2. Restrict the carbohydrates in your diet.

3. Eat whenever you feel hungry.

4. Select carbohydrates such as whole grains or legumes.

Correct Answer: 4

Rationale 1: Moderate alcohol consumption is permitted, within the dietary prescription.

Rationale 2: Restricting carbohydrates to less than 130 grams per day is not recommended.

Rationale 3: Maintaining a normal weight is important to the management of diabetes; eating whenever hungry is not consistent with the diabetic food prescription.

Rationale 4: Complex carbohydrates such as whole grains, legumes, fruits, and those with low glycemic indices will limit spikes in blood glucose values.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-4

Question 30

Type: MCSA

A patient has been admitted for treatment of diabetic ketoacidosis (DKA). The nurse should include which intervention in the patients plan of care?

1. Place the patient on strict bed rest.

2. Monitor intravenous fluid administration.

3. Review the diabetic diet with the patient.

4. Administer oral hypoglycemics on schedule.

Correct Answer: 2

Rationale 1: Activity level will depend on the patients condition. Bed rest is not required.

Rationale 2: Hyperglycemia creates an osmotic diuresis and leads to dehydration. Treatment will include fluid replacement.

Rationale 3: Dietary teaching is not the priority at this time.

Rationale 4: It is more likely that this patient will be treated with insulin.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-1

Question 31

Type: MCSA

Which nursing diagnosis is of the highest priority for the patient presenting with hyperosmolar hyperglycemic syndrome (HHS)?

1. Altered Nutrition: More than Body Requirement

2. Deficient Fluid Volume

3. Noncompliance related to self-management

4. Knowledge Deficit related to diabetic diet

Correct Answer: 2

Rationale 1: The etiology of HHS is not related to overeating.

Rationale 2: The patient with HHS typically has blood glucose levels >600 mg/dL, which leads to profound osmotic diuresis and dehydration. This syndrome may develop more frequently in type 2 diabetics who are ill and have unreplaced fluid losses.

Rationale 3: Noncompliance with self-management is too broad a category to address in a critically ill patient.

Rationale 4: While proper diet is important in diabetes management, dietary indiscretion is not the main cause of HHS.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 47-6

Question 32

Type: FIB

The nurse is providing dietary instruction to a patient diagnosed with type 2 diabetes. The nurse includes information on how to reduce dietary intake of cholesterol to no more than _______ mg per day.

Standard Text: 

Correct Answer: 200

Rationale : Dietary cholesterol intake for a patient with diabetes should be limited to no more than 200 mg/day.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-4

Question 33

Type: MCMA

An obese patient diagnosed with type 2 diabetes would like to achieve a healthy weight. The patient says, My girlfriend lost a lot of weight on a high-protein diet. Which nursing responses are indicated?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. You might try the diet for a few weeks and see how your weight and blood glucose respond.

2. You should keep your protein intake to about 15% to 20% of your diet.

3. You would probably be more successful if you restricted your carbohydrate intake to less than 130 grams a day.

4. If you make healthy food choices and increase your exercise, you should experience weight loss.

5. You should avoid starchy foods, all sweets, and follow the American Diabetes Association exchange program.

Correct Answer: 2,4

Rationale 1: High-protein diets are not recommended as a method of weight loss.

Rationale 2: The diabetic patient should set a goal of 15% to 20% protein in the diet.

Rationale 3: Low-carbohydrate diets are not recommended in the management of diabetes.

Rationale 4: The focus of dietary management is to promote healthy food choices and physical activity.

Rationale 5: Avoidance of foods is the old way of managing the diabetic diet. Today, the patient is encouraged to make healthy food choices. Following a strict diet is not recommended for most patients.

Global Rationale: 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-4

Question 34

Type: MCMA

A 5-year-old patient is being treated for diabetic ketoacidosis. The patients blood glucose is normalizing and acidosis has been partially corrected. The childs mother says, This is the best rest he has gotten since we arrived yesterday. He hasnt moved in the last 20 minutes. What nursing interventions are indicated?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Dim the lights in the room to allow the child and mother to rest.

2. Wake the child and assess for changes in mental status.

3. Discontinue the 0.9NS IV infusion.

4. STAT page the childs health care provider.

5. Check the childs pupillary response.

Correct Answer: 2,5

Rationale 1: This is not the best intervention for this situation.

Rationale 2: The development of cerebral edema is a complication of DKA therapy. The resting noted by the mother may in fact be approaching coma. Assessment is critical.

Rationale 3: Infusion of 0.9NS by IV may help protect the patient from the development of cerebral edema.

Rationale 4: The nurse does not have enough information until assessment is done.

Rationale 5: The development of cerebral edema is a complication of DKA therapy. Brain herniation may occur. The nurse should assess for abnormal neurological signs such as changes in pupillary response.

Global Rationale: 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-6

Question 35

Type: MCMA

A patient has been prescribed metformin for treatment of type 2 diabetes. Which teaching would the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. You are likely to have one or two episodes of hypoglycemia while your body adjusts to this medication.

2. If you need any diagnostic testing that requires radiocontrast dye, be certain to report that you are taking metformin.

3. You may have mild stomach upset at first when taking this medication.

4. Take this medication just before you begin to eat.

5. You may develop a persistent cough while taking metformin.

Correct Answer: 2,3

Rationale 1: Metformin is not likely to produce hypoglycemia.

Rationale 2: Metformin should be discontinued prior to any procedure using radiocontrast dye.

Rationale 3: Gastrointestinal upset is common at the beginning of metformin therapy.

Rationale 4: There is no indication that metformin should be taken immediately preceding a meal. It is often taken at night.

Rationale 5: A cough is not a side effect of metformin.

Global Rationale: 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-3

Osborn, Medical-Surgical Nursing, 2e, Test Bank

Copyright 2014 by Pearson Education, Inc.

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