LORMA COLLEGES

College of Nursing
SY 2011-2012
FIRST SEMESTER
DM ACITIVITY

1.

MULTIPLE CHOICE
1. The nurse explains that type 1 diabetes mellitus is a disease in which the body does not
produce enough insulin so my blood glucose is elevated because of
1. prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon, growth hormone).
2. malfunction of the glycogen-storing capabilities of the liver.
3. destruction of the beta cells in the pancreas.
4. insulin resistance of the receptor cells of the muscle tissue.
RATIONALE:________________________________________________________________________________
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2. When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a
pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but:
1. overweight and underactive people simply cannot use the insulin produced.
2. metabolism is slowed in some people so they have to take a pill to speed up their metabolism.
3. sometimes the autoimmune system works against the action of the insulin.
4. the cells become resistant to the action of insulin. Pills are given to increase the sensitivity.
RATIONALE:________________________________________________________________________________
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3. A patient tells the nurse that she eats huge amounts of food but stays hungry most of the
time. The nurse explains that hunger experienced by persons with type 1 diabetes is caused by
the:
1. excess amount of glucose
2. need for additional calories to correct the increased metabolism.
3. fact that the cells cannot use the blood glucose.
4. need for exercise to stimulate insulin secretion.
RATIONALE:________________________________________________________________________________
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4. The nurse stresses that the type 1 diabetic is at risk for cardiovascular disorders because lack
of insulin causes:
1. high glucose levels that irritate and shrink the vessels.
2. inadequate metabolism of proteins, which causes ketosis.
3. increased fatty acid levels.

4. increased metabolism of ketones, which causes hypertension.

RATIONALE:________________________________________________________________________________
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5. The goal of diabetic self-care is to keep the patients blood sugar level normal. Hyperglycemia
occurs when:
1. blood glucose levels rise, stimulating production of insulin.
2. insulin conversion of glycogen to glucose is inhibited.
3. the body responds to glucose-starved tissues by changing stored glycogen into glucose.
4. glycogen is unable to be stored in the liver and muscles.
RATIONALE:________________________________________________________________________________
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6. The young patient complains that diabetes is causing her to have no life at all . . . . Its too
hard. The most helpful response is:
1. Yes, you must make some sacrifices.
2. Its hard, but with significant alterations in your lifestyle, you can live a long life.
3. Whats hard about exercise, diet, and medicine?
4. Lets talk about what makes it so hard.
RATIONALE:________________________________________________________________________________
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7. When the type 2 diabetic patient says, Why in the world are they looking at my hemoglobin? I
thought my problem was with my blood sugar. The nurse responds that the level of hemoglobin
A1c:
1. shows how a high glucose level can cause a significant drop in the hemoglobin level.
2. shows what the glucose level has done for the last 3 months.
3. indicates a true picture of the patients nutritional state.
4. reflects the effect of high glucose levels on the ability to produce red blood cells.
RATIONALE:________________________________________________________________________________
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8. The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 AM. Based on the
reading of 72, the nurse should:
1. notify the charge nurse of the reading.
2. give regular insulin per sliding scale.
3. give him cup of milk.
4. administer the oral hyperglycemic tablet.
RATIONALE:________________________________________________________________________________
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9. The nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a
life-threatening condition that results in:
1. the inability of carbohydrates, fats, and proteins to be metabolized.
2. the storage of glycogen, so that there is a severe shortage of glucose in the bloodstream.
3. dangerously elevated pH and bicarbonate levels in the blood.
4. severe hypoglycemia, which can result in coma and convulsions.
RATIONALE:________________________________________________________________________________
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10. The patient has been admitted to the hospital with the diagnosis of diabetic ketoacidosis. The
nurse anticipates that the patient will exhibit vital signs of:
1. T, 99; P, 62; R, 16 and shallow.
2. T, 98.6; P, 76; R, 16 and deep.
3. T, 98; P, 84; R, 18 and shallow.
4. T, 97.4; P, 100; R, 20 and deep.
RATIONALE:________________________________________________________________________________
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11. The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6
months. The nurse is surprised and concerned about a blood glucose reading of 52. This episode
of hypoglycemia is probably caused by the patients having:
1. taken a new form of birth control pill this morning.
2. used large amounts of sugar substitute in her tea this morning.
3. had a 2-hour long exercise class at the spa this morning.
4. underdosed herself with insulin this morning.
RATIONALE:________________________________________________________________________________
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12. As part of the teaching plan in preparation for discharge, the patient with type 1 diabetes
needs guidelines for exercise. Be sure to include which of the following?
1. Plan your exercise so that it coincides with the peak action of insulin.
2. Insulin should be injected into the lower extremity before exercise because that site provides the greatest
absorption.
3. Exercise should be done daily at the same time of day and at the same intensity.
4. Keep exercise at a minimum to conserve your energy.
RATIONALE:________________________________________________________________________________
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13. The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has
ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The proper
procedure is to:
1. draw up the insulins in two separate syringes so that there can be no confusion.

2. draw up the regular insulin before drawing up the NPH insulin.

3. inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear regular insulin and withdraw
to 45 U.
4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular
insulin, and withdraw 35 U of the NPH insulin.
RATIONALE:________________________________________________________________________________
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14. A patient has come into the emergency room with her friend. Her friend states that she had
been acting very strangely and confused. The friend states that the patient has diabetes and
takes insulin. The nurse knows that signs and symptoms of hypoglycemia include:
1. slow pulse rate and low blood pressure.
2. irritability, anxiety, confusion, and dizziness.
3. flushing, anger, and forgetfulness.
4. sleepiness, edema, and sluggishness.
RATIONALE:________________________________________________________________________________
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15. A patient has come to the doctors office after finding out that her blood glucose level was
135 mg/dL. She states that she had not eaten before the test and was told to come and see her
doctor. She asks you if she has diabetes. The nurse responds:
1. Having a fasting serum glucose that high certainly indicates diabetes.
2. That test indicates that we need to do more tests that are specific for diabetes.
3. How do you feel? Do you have any other signs of diabetes?
4. Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a
diagnosis.
RATIONALE:________________________________________________________________________________
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16. The teaching plan for a 22-year-old woman on Avandia (rosiglitazone) would include a
caution relative to:
1. decreased effectiveness of her birth control pills.
2. excessive exposure to the sun.
3. sudden drop in blood pressure with dizziness.
4. possible severe diarrhea.
RATIONALE:________________________________________________________________________________
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17. The type 1 diabetic patient has an insulin order for NPH insulin, 35 U, to be given at 7 AM. The
patient is also NPO for laboratory work that will not be drawn until 10 AM. The nurse should:
1. give the insulin as ordered.
2. give the insulin with a small snack.
3. inform the charge nurse.

4. hold the insulin until after the blood draw.

RATIONALE:________________________________________________________________________________
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18. The patient comes to the diabetes clinic and confides to the nurse that she does not follow the
diet exchange program that she was given. You respond:
1. The exchange program is a carefully developed and very important program that allows you to take control
of your disease.
2. A lot of people have trouble with that program. You arent the first one to go off your diet.
3. We had better go ahead and check your blood work to see what youve done to yourself.
4. Okay. Lets talk about what you do eat and drink and how you manage your diabetes.
RATIONALE:________________________________________________________________________________
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19. When the Type 1 diabetic patient asks why his 7 AM insulin has been changed from NPH
insulin to 70/30 premixed insulin, the nurse explains that 70/30 insulin:
1. is absorbed more rapidly into the bloodstream.
2. has no peak action time and lasts all day.
3. makes insulin administration easier and safer.
4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.
RATIONALE:________________________________________________________________________________
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20. In drawing up a patient diabetes teaching plan, the nurse needs to include the following:
1. Develop an exercise plan, because regular exercise helps control your blood glucose level.
2. Monitor your blood sugar only if you are not feeling well so that you dont prick your fingertips too much.
3. If you are experiencing nervousness, palpitations, or hunger, take a small dose (1 to 2 U) of regular insulin
and call the doctor.
4. Use over-the-counter measures for any foot blisters, calluses, or wounds before you seek medical help.
RATIONALE:________________________________________________________________________________
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21. A patient who has been diagnosed with endogenous hypoglycemia most likely has:
1. taken an overdose of hypoglycemic drugs.
2. been following a very restricted fasting diet or is malnourished.
3. excessive secretion of insulin or an increase in glucose metabolism.
4. exercised unwittingly without replenishing needed fluid and nutrients.
RATIONALE:________________________________________________________________________________
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22. The nurse giving Humulin R 20 U at 7 AM is aware that this drug will peak in:
1. 15 minutes.
2. 30 minutes.
3. 1 hour.
4. 2 hours.
RATIONALE:________________________________________________________________________________
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23. It is recognized that people with diabetes are at greater risk for complications than
nondiabetic patients because of:
1. high blood pressure, which can lead to a stroke.
2. genetic susceptibility, which leads to a generalized weakening of the immune system.
3. thickening of the basement membrane of the capillaries.
4. chronic pain, which leads to activity intolerance.
RATIONALE:________________________________________________________________________________
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24. The nurse suspects that the patient with type 1 diabetes may be experiencing the Somogyi
phenomenon when the patient exhibits:
1. headache on awakening and enuresis.
2. 6 AM blood sugar of 58 and nausea.
3. abdominal pain and blood pressure elevation.
4. drowsiness and disorientation after eating.
RATIONALE:________________________________________________________________________________
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25. The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome
(HHNKS). Her blood glucose level is very high (880 mg/dL on admission). The physician believes
that her condition is to the result of large amounts of glucose solutions administered
intravenously during kidney dialysis. The nurse would anticipate that the patient would exhibit:
1. a fruity breath and high level of ketones in her urine.
2. severe dehydration and hypernatremia caused by the hyperglycemia.
3. exactly the same symptoms and signs as diabetic ketoacidosis.
4. Kussmauls respirations, nausea, and vomiting.
RATIONALE:________________________________________________________________________________
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26. The nurse tells a patient that the functional causes of hypoglycemia include (select all that
apply):
1. dumping syndrome.
2. overdose of insulin.
3. Addisons disease.
4. spontaneous hypoglycemia.

5. chronic alcoholism.
RATIONALE:________________________________________________________________________________
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27. The teaching plan for a diabetic patient for foot care would include that the patient should
(select all that apply):
1. wash and carefully dry the feet every day.
2. apply lotion between the toes.
3. protect the feet from extreme temperatures.
4. walk barefoot only indoors.
5. buy shoes that are comfortable and supportive.
RATIONALE:________________________________________________________________________________
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28. The teaching plan for a diabetic is focused on smoking cessation and control of hypertension
for the avoidance of microvascular complications, such as (select all that apply):
1. macular degeneration.
2. end-stage renal disease (ESRD).
3. coronary artery disease (CAD).
4. peripheral vascular disease (PVD).
5. cerebrovascular accident (CVA).
RATIONALE:________________________________________________________________________________
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29. The nurse instructs a patient about how insulin affects blood glucose. Arrange the events in
sequence.
1. Beta cells are stimulated to release insulin.
2. Glucose enters the bloodstream.
3. Glycogen is converted to glucose by alpha cells (glycogenesis).
4. Glycogen is stored in the liver.
5. Insulin transports glucose to muscle cells.
RATIONALE:________________________________________________________________________________
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