1. 1.

Question

1 point(s)

Knowing that gluconeogenesis helps to maintain blood glucose levels, a nurse should:

A. Document weight changes because of fatty acid mobilization.

B. Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue
insulation.

C. Protect the patient from sources of infection because of decreased cellular protein deposits.

Incorrect

D. Do all of the above.

Correct answer

Incorrect

Correct answer: D. Do all of the above

All measures ensure gluconeogenesis in maintaining glucose homeostasis. The purpose of

gluconeogenesis is to maintain blood glucose levels during a fast. In the human body, some tissues
rely almost exclusively on glucose as a metabolic fuel source.

 Option A: Fatty acid oxidation is indispensable for gluconeogenesis; although fatty

acid carbon cannot be used for glucose, fat oxidation provides both an energy source
(ATP) to support gluconeogenesis and acetyl coenzyme A (acetyl-CoA) to activate
pyruvate carboxylase.

 Option B: Cold exposure is associated with hypothalamic signals to constrict the

peripheral blood vessels, minimize sweat production, and increase metabolic heat
production (i.e., shivering and nonshivering thermogenesis) during prolonged and/or
severe cold exposure to prevent dangerous drops in core temperature.

 Option C: A protein deficit can also take its toll on the immune system. Impaired
immune function may increase the risk or severity of infections, a common symptom
of severe protein deficiency.

2. 2. Question

1 point(s)

The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect
the following symptoms during an assessment, except:

A. Hypoglycemia

Correct answer

B. Frequent bruising

Incorrect

C. Ketonuria
D. Dry mouth

Incorrect

Correct answer: A. Hypoglycemia

Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking
other diabetes medication. In T2DM, the response to insulin is diminished, and this is defined as
insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in
insulin production to maintain glucose homeostasis, but over time, insulin production decreases,
resulting in T2DM.

 Option B: Type 2 diabetes can affect blood circulation which makes it easier for the
skin to bruise. Decreased blood flow to the area surrounding an injury prevents a
wound from healing properly, resulting in the development of bruise-like lesions or
spots.

 Option C: The presence of ketones in the urine happens due to a lack of available
insulin. T1DM patients can often present with ketoacidosis (DKA) coma as the first
manifestation in about 30% of patients.

 Option D: Losing a lot of fluids caused by frequent urination can lead to dehydration
hence patients can develop dry mouth. People with diabetes are prone to
dehydration. In those with diabetes, a person’s blood glucose levels can become too
high. The term for this is hyperglycemia, and it can cause a person to experience dry
mouth.

3. 3. Question

1 point(s)

Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual
over the previous three months. Which of the following values is considered a diagnosis of pre-
diabetes?

A. 6.5-7%

B. 5.7-6.4%

Correct

C. 5-5.6%

D. >5.6%

Correct

Correct Answer: B. 5.7-6.4%

Glycosylated hemoglobin levels between 5.7%-6.4% are considered as pre-diabetes. The hemoglobin
A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a
person’s level of glucose control. The test shows an average of the blood sugar level over the past 90
days and represents a percentage. Anyone with an HbA1c value of 5.7 % to 6.4 % is considered to be
prediabetic
  Option A: Glycosylated hemoglobin levels over 6.5 % are considered diagnostic of
diabetes. Diabetes can be diagnosed with an HbA1c of 6.5% or higher. The American
Diabetes Association (ADA) recommends that the HbA1c is checked twice a year in
patients that are stable and well-controlled, versus every 3 months in patients with
changes in their medications, or not well controlled.

 Options C and D: Glycosylated hemoglobin levels less than 5.6 % are normal. For an
HbA1c test to classify as normal, or in the non-diabetic range, the value must be
below 5.7 %. Tests should be sent to a laboratory certified by the NGSP to ensure
results are standardized.

4. 4. Question

1 point(s)

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and
should be used only every:

A. Third day

B. Every other day

Incorrect

C. 1-2 weeks

Correct answer

D. 2-4 weeks

Incorrect

Correct Answer: C. 1-2 weeks

Rotation of sites for insulin injection should be done every week or two. Frequently using the same
spot over time can cause fat cells to break down or build up (lipodystrophy) causing lumps under the
skin and may interfere with insulin absorption.

 Option A: Avoid injecting into the same site over and over. This can irritate the skin
and underlying fatty tissue. When rotating injections, move around within the area
to ensure that the injection does not always take place in exactly the same spot.

 Option B: Puncturing the same point every time can lead to hard lumps or fatty
deposits developing. This can be uncomfortable and even reduce the body’s
effectiveness in absorbing the medication.

 Option D: If a person always administers a morning dose of rapid-acting insulin into

their abdomen, they should alternate between different areas of the abdomen to
avoid repeated injections into the same site.

5. 5. Question

1 point(s)

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

A. Blurred vision
B. Diaphoresis

Correct

C. Nausea

D. Weakness

Correct

Correct Answer: B. Diaphoresis

A hypoglycemic reaction activates a fight-or-flight response in the body which then triggers the
release of epinephrine and norepinephrine resulting in diaphoresis. Low blood sugars can affect
activity in the autonomic nervous system (ANS), which is responsible for reactions that people
cannot control, such as sweating and digestion. The cholinergic system is a part of the ANS, and it
regulates the production of sweat and other secretions. Activation of this system can lead to
sweating.

 Option A: High levels of blood sugar resulting from diabetes can affect your ability to
see by causing the lens inside the eye to swell, which can result in temporary
blurring of eyesight. Blurring of vision may also occur as a result of very low blood
sugar levels.

 Option C: Diabetic ketoacidosis occurs when blood sugar levels become very high,
and ketones build up to dangerous levels in the blood. One common symptom of
diabetic ketoacidosis is severe nausea. Both hyperglycemia and hypoglycemia can
make a person feel nauseated.

 Option D: Hypoglycemia can lead to symptoms such as dizziness, weakness, and, in

severe cases, a loss of consciousness. Symptoms of hyperglycemia in DKA are
common, including polyuria, polydipsia, and sometimes more severe presentations
include unintentional weight loss, vomiting, weakness, and mentation changes.

6. 6. Question

1 point(s)

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired
peripheral arterial circulation includes all of the following, except:

A. Integumentary inspection for the presence of brown spots on the lower extremities

B. Observation for paleness of the lower extremities

Incorrect

C. Observation for blanching of the feet after the legs are elevated for 60 seconds

D. Palpation for increased pulse volume in the arteries of the lower extremities

Correct answer

Incorrect

Correct Answer: D. Palpation for increased pulse volume in the arteries of the lower extremities
One of the signs and symptoms of impaired peripheral arterial circulation is the absence of a pulse or
a weak pulse in the legs or feet. A general concept to bear in mind is that anything impinging the
vessel can decrease peripheral pulses.

 Option A: This happens when high pressure in the veins pushes blood into the skin
tissue causing reddish-brown staining in the skin tissue. When skin is stained like
this, it is very fragile and may break down or, if knocked, fail to heal as usual.

 Option B: Severe vasoconstriction reduces blood flow to the skin of the affected
areas, causing the skin surface to feel cold to touch and to have a white color. The
pale white color is due to virtually no blood flow to the skin.

 Option C: When a person develops impaired peripheral arterial circulation, the

extremities — usually the legs — don’t receive enough blood flow and oxygen to
keep up with demand leading to a change in the color of the legs.

7. 7. Question

1 point(s)

The nurse expects that a type 1 diabetic may receive how much of his or her morning dose of insulin
preoperatively?

A. 10-20%

B. 25-40%

Incorrect

C. 50-60%

Correct answer

D. 85-90%

Incorrect

Correct Answer: C. 50-60%

Surgical procedures may result in a number of metabolic perturbations that can alter normal glucose
homeostasis. Patients with type 1 diabetes mellitus who are using long-acting insulins, such as
glargine, should continue these as normal when fasting. Patients taking premixed insulins or fixed-
combination insulins are more of a challenge. It may not be feasible or economical to change the
patient’s premixed insulin just before surgery. In these situations, the patient can take ½ – ¾ of the
morning dose, followed by administration of a dextrose-containing intravenous fluid and frequent
blood glucose checks.

 Option A: However, in patients who take high doses of basal insulin (>60% of total
daily insulin) or total daily insulin dose is greater than 80 units or are at high risk of
hypoglycemia (elderly, renal or hepatic insufficiency, prior hypoglycemic episodes);
basal insulin dose should be reduced by 50 to 75% to minimize hypoglycemia risk.

 Option B: Patients who are on home insulin therapy should reduce the dose of long-
acting basal insulin (glargine, detemir) by 20-25% the evening before surgery. If they
 routinely take basal insulin only in the morning, then the reduced dose should
instead be administered on the morning of surgery.

 Option D: If the patient is prone to morning hypoglycemia, the dose can be reduced
by 20%. Thus, the diabetic patient may receive 80% of his or her morning dose of
insulin preoperatively.

8. 8. Question

1 point(s)

Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of

pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH.
Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The
nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

A. 1130 and 1330

B. 1330 and 1930

Correct answer

C. 1530 and 2130

Incorrect

D. 1730 and 2330

Incorrect

Correct Answer: B. 1330 and 1930

The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an
intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later,
and is effective for about 12 to 16 hours.

 Option A: NPH human insulin has an onset of insulin effect of 1 to 2 hours, a peak
effect of 4 to 6 hours, and a duration of action of more than 12 hours. Very small
doses will have an earlier peak effect and shorter duration of action, while higher
doses will have a longer time to peak effect and prolonged duration.

 Option C: Regular human insulin has an onset of action of 1/2 hour to 1 hour, peak
effect in 2 to 4 hours, and duration of action of 6 to 8 hours. The larger the dose of
regular the faster the onset of action, but the longer the time to peak effect and the
longer the duration of the effect.

 Option D: Long-acting insulin analogs have an onset of insulin effect in 1 1/2-2 hours.
The insulin effect plateaus over the next few hours and is followed by a relatively flat
duration of action that lasts 12-24 hours for insulin detemir and 24 hours for insulin
glargine.

9. 9. Question

1 point(s)
A male nurse is providing a bedtime snack for his patient. This is based on the knowledge that
intermediate-acting insulins are effective for an approximate duration of:

A. 6-8 hours

B. 10-14 hours

Incorrect

C. 14-18 hours

Correct answer

D. 24-28 hours

Incorrect

Correct Answer: C. 14-18 hours

Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four
hours, a peak of 4 to 12 hours, and a duration of 14 to 18 hours. They are absorbed more slowly, and
last longer. They are also used to control the blood sugar overnight while fasting and between meals.

 Option A: Regular or short-acting insulins include Humulin R and Novolin R. They

have an onset of half an hour, a peak of two to three hours, and a duration of six to
eight hours. The larger the dose of regular the faster the onset of action, but the
longer the time to peak effect and the longer the duration of the effect.

 Option B: NPH human insulin has an onset of insulin effect of 1 to 2 hours, a peak
effect of 4 to 6 hours, and a duration of action of more than 12 hours. Very small
doses will have an earlier peak effect and shorter duration of action, while higher
doses will have a longer time to peak effect and prolonged duration.

 Option D: Long-acting insulins include Levemir and Lantus. They have an onset of
several hours, minimal or no peak, and a duration of 24 hours or more. The insulin
effect plateaus over the next few hours and is followed by a relatively flat duration of
action that lasts 12-24 hours for insulin detemir and 24 hours for insulin glargine.

10. 10. Question

1 point(s)

A nurse went to a patient’s room to do routine vital signs monitoring and found out that the patient’s
bedtime snack was not eaten. This should alert the nurse to check and assess for:

A. Elevated serum bicarbonate and decreased blood pH

B. Signs of hypoglycemia earlier than expected

Correct

C. Symptoms of hyperglycemia during the peak time of NPH insulin

D. Sugar in the urine

Correct

Correct answer: B. Signs of hypoglycemia earlier than expected.

Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and
lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m.
The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic
patients. The thinking is that these patients should monitor their blood glucose levels and adjust
insulin dosages as necessary to prevent hypo- or hyperglycemic episodes.

 Option A: Normal human physiological pH is 7.35 to 7.45. A decrease in pH below

this range is acidosis, an increase over this range is alkalosis. Metabolic alkalosis is
defined as a disease state where the body’s pH is elevated to greater than 7.45
secondary to some metabolic process.

 Option C: For many years, the most common insulin used to provide a basal insulin
supply has been NPH insulin, but this intermediate-acting insulin often results in
nocturnal hypoglycemia due to unwanted plasma insulin peaks, particularly during
the night, as well as higher fasting glucose levels.

 Option D: Glucosuria connotes the presence of glucose in the urine and is the most
frequent type of glycosuria and is the focus of this review. It happens when the
glomerulus filters more glucose than the proximal tubule can reabsorb.

11. 11. Question

1 point(s)

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely
time for a hypoglycemic reaction to occur is:

A. 2-4 hours after administration

B. 6-14 hours after administration

Correct answer

C. 16-18 hours after administration

Incorrect

D. 18-24 hours after administration

Incorrect

Correct Answer: B. 6-14 hours after administration

The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an
intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later,
and is effective for about 12 to 16 hours.

 Option A: Regular human insulin has an onset of action of 1/2 hour to 1 hour, peak
effect in 2 to 4 hours, and duration of action of 6 to 8 hours. The larger the dose of
regular the faster the onset of action, but the longer the time to peak effect and the
longer the duration of the effect.

 Option C: Pre-mixed insulin is NPH pre-mixed with either regular human insulin or a
rapid-acting insulin analog. The insulin action profile is a combination of short and
intermediate-acting insulins.
  Option D: Long-acting insulin analogs have an onset of insulin effect in 1 1/2-2 hours.
The insulin effect plateaus over the next few hours and is followed by a relatively flat
duration of action that lasts 12-24 hours for insulin detemir and 24 hours for insulin
glargine.

12. 12. Question

1 point(s)

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

A. Gives a small continuous dose of regular insulin subcutaneously, and the client can self-administer
a bolus with an additional dosage from the pump before each meal.

Correct answer

B. It is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific
intervals.

Incorrect

C. It is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn
releases the insulin into the bloodstream.

D. It continuously infuses small amounts of NPH insulin into the bloodstream while regularly
monitoring blood glucose levels.

Incorrect

Correct Answer: A. Gives a small continuous dose of regular insulin subcutaneously, and the client
can self-administer a bolus with an additional dosage 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 additional dosage from the pump
before each meal as needed. Regular insulin is used in an insulin pump.

 Option B: Pumps are designed to mimic the natural insulin delivery of the pancreas
by continuously delivering short-acting insulin at a basal rate required for
maintaining control of blood glucose when fasting. This rate can be set on an hourly
basis allowing for tighter control of blood sugars throughout the day.

 Option C: An external pump is not attached surgically to the pancreas. The Artificial
Pancreas Device System is a system of devices that closely mimics the glucose
regulating function of a healthy pancreas. Most Artificial Pancreas Device Systems
consist of three types of devices already familiar to many people with diabetes: a
continuous glucose monitoring system (CGM) and an insulin infusion pump. A blood
glucose device (such as a glucose meter) is used to calibrate the CGM.

 Option D: The artificial pancreas, also known as closed-loop control, is an “all-in-

one” diabetes management system that tracks blood glucose levels using a
continuous glucose monitor (CGM) and automatically delivers the hormone insulin
when needed using an insulin pump.

13. 13. Question

1 point(s)

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding
would a nurse expect to note as confirming this diagnosis?

A. Elevated blood glucose level and a low plasma bicarbonate

Correct answer

B. Decreased urine output

C. Increased respiration and an increase in pH

Incorrect

D. Comatose state

Incorrect

Correct Answer: A. Elevated blood glucose level and a low plasma bicarbonate

In diabetic acidosis, the arterial pH is less than 7.35, plasma bicarbonate is less than 15mEq/L, and
the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine.
Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and
increased body ketone concentration.

 Option B: Patients may have symptoms of hyperglycemia like polyphagia, polyuria,

or polydipsia. As patients become more volume-depleted, they may experience
decreased urine output, dry mouth, or decreased sweating indicative of dehydration.

 Option C: The client would be experiencing Kussmaul’s respirations. Kussmaul’s

breathing, which is labored, deep, and tachypneic, may occur. Some providers may
appreciate a fruity scent to the patient’s breath, indicative of the presence of
acetone.

 Option D: A comatose state may occur if DKA is not treated, but coma would not
confirm the diagnosis. In the most severe cases, altered mental status, general
drowsiness, and focal neurologic deficits can be appreciated and are signs of cerebral
edema. If found, this needs to be treated immediately.

14. 14. Question

1 point(s)

A client with DM demonstrates acute anxiety when first admitted for the treatment of
hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:

A. Administer a sedative

B. Make sure the client knows all the correct medical terms to understand what is happening

Incorrect

C. Ignore the signs and symptoms of anxiety so that they will soon disappear

D. Convey empathy, trust, and respect toward the client

Correct answer
Incorrect

Correct answer: D. Convey empathy, trust, and respect toward the client.

The most appropriate intervention is to address the client’s feelings related to anxiety. Establish and
maintain a trusting relationship by listening to the client; displaying warmth, answering questions
directly, offering unconditional acceptance; being available, and respecting the client’s use of
personal space.

 Option A: Administering a sedative is not the most appropriate intervention. PRN

medications may be indicated for high levels of anxiety. Watch out for adverse side
effects. Medication may be necessary to decrease anxiety to a level at which the
client can feel safe, but this should be considered the least.

 Option B: A client will not relate to medical terms, particularly when anxiety exists.
During a panic attack, the patient needs reassurance that he is not dying and the
symptoms will resolve spontaneously. In anxiety, the client’s ability to deal with
abstractions or complexity is impaired.

 Option C: The nurse should not ignore the client’s anxious feelings. Early detection
and intervention facilitate modifying the client’s behavior by changing the
environment and the client’s interaction with it, to minimize the spread of anxiety.

15. 15. Question

1 point(s)

A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia.
The priority nursing diagnosis would be:

A. High risk for deficient fluid volume

Correct answer

B. Deficient knowledge: disease process and treatment

Incorrect

C. Imbalanced nutrition: less than body requirements

D. Disabled family coping: compromised

Incorrect

Correct Answer: A. High risk for deficient fluid volume

Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is
accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid
loss must be replaced when it becomes severe.

 Option B: The focus of diabetes education should be patient empowerment to

address changes in health behavior and self-care. Providing complete information
and proper education to patients with diabetes can dramatically increase adherence
to the treatment regimen.
  Option C: Nutrition plays an important role in the management and treatment of
diabetes. Diabetes requires a balance between the intake of nutrients, expenditure
of energy, and timing and dose of insulin or oral antidiabetic agents.

 Option D: Compromised family coping may be related to inadequate or incorrect

information or understanding by primary persons, other situation crises or situations
the SO’s may be facing, lifelong conditions requiring behavioral changes impacting
the family.

16. 16. Question

1 point(s)

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing
action is to prepare to:

A. Administer regular insulin intravenously

Correct answer

B. Administer 5% dextrose intravenously

Incorrect

C. Correct the acidosis

D. Apply an electrocardiogram monitor

Incorrect

Correct Answer: A. Administer regular insulin intravenously

Lack (absolute or relative) of insulin is the primary cause of DK1. Intravenous insulin by continuous
infusion is the standard of care. A more recent prospective randomized trial demonstrated that a
bolus is not necessary if patients are given hourly insulin infusion at 0.14 U/kg/hr.

 Option B: Isotonic fluids have been well established for more than 50 years as
preferred fluids. Colloids vs. crystalloids were compared for critically ill patients, in a
2013 meta-analysis, and crystalloid was found to be non-inferior.

 Option C: Treatment consists of insulin administration (regular insulin), IV fluid

administration (normal saline initially), and potassium replacement, followed by
correcting acidosis. Immediate fluid resuscitation is vital to correct hypovolemia,
restore tissue perfusion, and to clear ketones. Hydration improves glycemic control
independent of insulin.

 Option D: Applying an electrocardiogram monitor is not a priority action. Hourly

point-of-care testing (POCT) glucose should be performed. Initial VBG or ABG
monitoring, followed by as-needed precipitating events.

17. 17. Question

1 point(s)
A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include
fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm,
and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse?

A. Pulse

B. Blood pressure

Incorrect

C. Respiration

D. Temperature

Correct answer

Incorrect

Correct Answer: D. Temperature

An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic

hyperosmolar nonketotic syndrome or diabetic ketoacidosis. Due to the possibility of an infectious
trigger for DKA, the patient may be febrile or hypothermic. If there is a superimposed infection that
triggered the episode of DKA, the patient may have other infectious symptoms like fever, cough, or
other urinary symptoms.

 Option A: The pulse rate of 88 bpm is normal. On examination, vital signs typically
reveal tachycardia and tachypnea. Supraventricular tachycardia (SVT) can occur as a
complication of diabetic ketoacidosis in the absence of underlying heart disease, and
the risk is increased by the electrolyte, acid-base, and fluid balance disturbances, as
in the previous case reports.

 Option B: A blood pressure of 140/84 mmHg is hypertensive. Blood pressure may

also vary, though hypotension is possible and indicative of a more severe disease
process. Insulin is known to decrease the catecholamine-induced production of
these 2 potent vasodilators. Severe insulin deficiency as seen in DKA thus leads to
increased production of PGI2 and PGE2, which leads to vasodilation and
hypotension.

 Option C: Respirations of 22 bpm are normal. Kussmaul’s breathing, which is

labored, deep, and tachypneic, may occur in clients with DKA. Some providers may
appreciate a fruity scent to the patient’s breath, indicative of the presence of
acetone.

18. 18. Question

1 point(s)

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia
with exercise. Which statement by the client indicated an inadequate understanding of the peak
action of NPH insulin and exercise?

A. “The best time for me to exercise is every afternoon.”

Correct answer
B. “The best time for me to exercise is right after I eat.”

Incorrect

C. “The best time for me to exercise is after breakfast.”

D. “The best time for me to exercise is after my morning snack.”

Incorrect

Correct Answer: A. “The best time for me to exercise is every afternoon.”

A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise
during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will
occur during the peak of the medication.

 Option B: Insulins of synthetic origin that have the same structure as human ones
generally have faster onset, quicker peak time, and shorter duration than their
previous animal counterparts and are less likely to cause allergic reactions. In just the
past decade, several rapid-acting insulins have hit (and taken over) the market from
regular insulin, including Humalog (generic name: lispro), NovoLog or NovoRapid
(aspart), Apidra (glulisine), and VIAject, an extremely rapid-acting formulation that is
absorbed in about half the time as Humalog.

 Option C: These products are actually insulin analogs; they have a structure similar
to that of insulin, but the order of the amino acids (i.e., protein building blocks) is
slightly modified, which results in faster absorption and shorter duration. The benefit
of these analogs for regular exercisers is that they’re mostly gone from the
circulation within two hours after they are taken, lowering the risk of getting low
when active later.

 Option D: A usual regimen is NPH at breakfast along with regular or Humalog to

cover breakfast, an optional rapid-acting injection at lunch, a mandatory one at
dinner, and another dose of NPH at bedtime. An alternative regimen is to take rapid-
acting insulin doses during the day with a single bedtime dose of NPH.

19. 19. Question

1 point(s)

A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been
well controlled with glyburide (Diabeta), 5 mg PO daily, but recently, the fasting blood glucose has
been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have
contributed to the hyperglycemia?

A. prednisone (Deltasone)

Correct answer

B. atenolol (Tenormin)

Incorrect

C. phenelzine (Nardil)

D. allopurinol (Zyloprim)
Incorrect

Correct Answer: A. prednisone (Deltasone)

Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium
supplements. Prednisone may interfere with blood glucose control and reduce the effectiveness of
metFORMIN and other diabetic medications. Monitor blood sugar levels closely. The client may need
a dose adjustment of the diabetic medications during and after treatment with prednisone.

 Option B: Research results indicated that atenolol can inhibit urinary excretion of
metformin via decreasing renal rMate1 expression, and long-term atenolol and
metformin co-administration may induce potential lactic acidosis.

 Option C: Phenelzine may lower blood sugar levels. However, it does not have any
effects when taken with oral hypoglycemic agents. Some products that may interact
with this drug include: other antidepressants (including maprotiline, mirtazapine,
nefazodone, TCAs such as amitriptyline/nortriptyline), appetite suppressants (such
as diethylpropion), drugs for attention deficit disorder (such as atomoxetine,
methylphenidate), apraclonidine, bupropion, etc.

 Option D: No interactions were found between allopurinol and metformin.

Allopurinol may also increase the risk of developing a rash if taken with antibiotics
ampicillin or amoxicillin. Allopurinol may also increase the effect of warfarin and
other drugs that thin the blood. These are known as anticoagulants.

20. 20. Question

1 point(s)

Glucose is an important molecule in a cell because this molecule is primarily used for:

A. Extraction of energy

Correct answer

B. Synthesis of protein

C. Building of genetic material

Incorrect

D. Formation of cell membranes

Incorrect

Correct Answer: A. Extraction of energy

Glucose catabolism is the main pathway for cellular energy production. It is a ubiquitous source of
energy for every organism in the world and is essential to fuel both aerobic and anaerobic cellular
respiration. Once glucose is in the body, it travels through the blood and to energy-requiring tissues.

 Option B: Protein synthesis involves a complex interplay of many macromolecules.

As one of the foundational concepts in biology, protein synthesis is sufficiently
complex that many believe it evolved once, giving the protein synthetic machinery in
all organisms on the planet a common ancestry.
  Option C: DNA is made of chemical building blocks called nucleotides. These building
blocks are made of three parts: a phosphate group, a sugar group, and one of four
types of nitrogen bases. To form a strand of DNA, nucleotides are linked into chains,
with the phosphate and sugar groups alternating.

 Option D: The formation of biological membranes is based on the properties of

lipids, and all cell membranes share a common structural organization: bilayers of
phospholipids with associated proteins. In addition, membrane proteins control the
interactions between cells of multicellular organisms.

21. 21. Question

1 point(s)

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the
nurse’s priority is to provide:

A. Oxygen

B. Carbohydrates

Incorrect

C. Fluid replacement

Correct answer

D. Dietary instruction

Incorrect

Correct Answer: C. Fluid replacement

As a result of osmotic pressures created by increased serum glucose, the cells become dehydrated;
the client must receive fluid and then insulin. Aggressive hydration with isotonic fluid with electrolyte
replacement is the standard practice in the management of HHS. An initial fluid bolus of 15 to 20
ml/kg followed by an infusion rate of 200 to 250ml/hour is the recommended rate for adults.

 Option A: Appropriate resuscitation with attention to the principle of Airway,

Breathing, Circulation (ABC) should be initiated. Patients with HHS can present with
altered mental status as a result of significant fluid depletion and decreased cerebral
perfusion. A good rule of thumb is to secure the airway if the Glasgow coma score is
less than 8.

 Option B: Hydration with isotonic fluid has been shown to help in reducing the
amount of counterregulatory hormones produced during HHS. The use of this alone
can reduce serum glucose by about 75 to 100 mg/hour.

 Option D: The serum potassium in HHS is usually high, but the total body potassium
is low as a result of the extracellular shift from lack of insulin. Potassium replacement
should be started when the serum potassium is between 4 to 4.5 mmol/L.

22. 22. Question

1 point(s)
The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should
expect. Select all that apply.

A. Thirst

B. Palpitations

Correct

C. Diaphoresis

Correct answer

D. Slurred speech

Correct answer

E. Hyperventilation

Incorrect

Correct Answers: B, C, & D.

Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs
and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL. The clinical
manifestations of hypoglycemia can be classified as either neuroglycopenic or neurogenic.

 Option A: Excessive thirst may be a symptom of high blood sugar (hyperglycemia).

It’s important to be able to recognize any imbalance in thirst or urine production. It’s
the function of the kidneys and other organs to help filter out impurities.

 Option B: Palpitations, an adrenergic symptom, occur as the glucose levels fall; the
sympathetic nervous system is activated and epinephrine and norepinephrine are
secreted causing this response.

 Option C: Neurogenic signs and symptoms can either be adrenergic (tremor,

palpitations, anxiety) or cholinergic (hunger, diaphoresis, paresthesias). Diaphoresis
is a sympathetic nervous system response that occurs as epinephrine and
norepinephrine are released.

 Option D: Neuroglycopenic signs and symptoms are signs and symptoms that result
from direct central nervous system (CNS) deprivation of glucose. Slurred speech is a
neuroglycopenic symptom; as the brain receives insufficient glucose, the activity of
the CNS becomes depressed.

 Option E: Rapid or labored breathing, known as Kussmaul breathing, can be a

symptom of diabetic ketoacidosis (DKA). Ketoacidosis is a short-term complication of
diabetes caused by very high blood glucose levels accompanied by a high level of
ketones in the blood.

23. 23. Question

1 point(s)

When a client is experiencing diabetic ketoacidosis, the insulin that would be administered is:

A. Human NPH insulin

B. Human regular insulin

Correct answer

C. Insulin lispro injection

Incorrect

D. Insulin glargine injection

Incorrect

Correct Answer: B. Human regular insulin

Regular insulin (Humulin R) is short-acting insulin and is administered via IV with an initial dose of 0.3
units/kg, followed by 0.2 units/kg 1 hour later, followed by 0.2 units/kg every 2 hours until blood
glucose becomes <13.9 mmol/L (<250 mg/dL). At this point, the insulin dose should be decreased by
half, to 0.1 units/kg every 2 hours, until the resolution of DKA.

 Option A: NPH insulin is FDA-approved in the adult and pediatric population to

control type 1 and type 2 diabetes mellitus. It is currently the most widely used basal
insulin that simulates the physiological basal insulin action. American Diabetes
Association guidelines recommend an NPH insulin dose of 0.4 to 1.0 units/kg/day
subcutaneously to manage type 1 diabetes mellitus.

 Option C: Insulin lispro is an insulin analog that is FDA-approved for the treatment of
patients with diabetes mellitus types 1 and 2 to control hyperglycemia. Its off-label
uses include treating patients with mild-to-moderate diabetic ketoacidosis,
gestational diabetes mellitus, and mild-to-moderate hyperosmolar hyperglycemic
state.

 Option D: Insulin glargine is a manmade version of human insulin that is FDA

approved to treat adults and children with type 1 diabetes and adults with type 2
diabetes to improve and maintain glycemic control. Insulin glargine is a long-acting
insulin injected once daily and provides a basal level of insulin throughout the day.

24. 24. Question

1 point(s)

The nurse recognizes that additional teaching is necessary when the client who is learning alternative
site testing (AST) for glucose monitoring says:

A. “I need to rub my forearm vigorously until warm before testing at this site.”

B. “The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”

Correct

C. “I have to make sure that my current glucose monitor can be used at an alternate site.”

D. “Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

Correct

Correct Answer: B. “The fingertip is preferred for glucose monitoring if hyperglycemia is

suspected.”
The fingertip is preferred for glucose monitoring if hypoglycemia, not hyperglycemia, is suspected.
AST (Alternate Site Testing) means using a part of the body other than the fingertips to obtain blood
for blood sugar testing.

 Option A: Don’t squeeze the fingertip vigorously. Instead, hang the hand and arm
down, allowing blood to pool in the fingertips. Washing the hands with warm water
may also increase blood flow.

 Option C: Alternate site testing is not possible with all blood glucose meters. Newer
machines only require a smaller drop of blood to provide accurate blood glucose
readings from other parts of the body.

 Option D: According to reports, routine blood glucose level testing before meals or
two or more hours after meals from alternate sites is equivalent to fingertip testing.
Therefore, testing when blood glucose is falling rapidly or rising rapidly is likely to be
less accurate from alternate sites.

25. 25. Question

1 point(s)

A 44-year-old woman with type 1 diabetes comes to the emergency department due to abdominal
pain accompanied by nausea and vomiting. The patient had a history of chronic back pain due to a
motor accident 20 years ago. Her situation renders her unable to work and pay for the increasing
price of insulin, which has doubled during the last five years. The patient doesn’t have medical
coverage or insurance; therefore, she rations her insulin intake, making her unable to follow her
prescribed therapeutic regimen for her diabetes. Because of her situation, the client is at high risk of
developing diabetic ketoacidosis. As her nurse, which of the following symptoms would you
anticipate the client to exhibit? Select all that apply.

A. Fruity odor breath

Correct

B. Deep and labored respirations

Correct answer

C. Blurred vision

Correct answer

D. Increased urination

Correct answer

E. Increased thirst

Correct answer

F. Fatigue

Correct answer

G. Blood glucose level of 60 mg/dL

H. Dehydration
Correct answer

I. Respiratory rate of 8 bpm

J. Hypernatremia

K. Metabolic alkalosis

Incorrect

Correct Answers: A, B, C, D, E, F, & H.

Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and

increased body ketone concentration. It is a life-threatening complication of diabetes and is usually
seen in patients with type-1 diabetes mellitus.

 Option A: Fruity odor breath or acetone breath occurs with elevated ketone levels.
Insulin deficiency causes lipolysis into free fatty acids and glycerol. These free fatty
acids are converted into ketones by the liver.

 Option B: Deep and labored respiration is another indication of high ketones in the
body. This type of respiration (Kussmaul breathing) is an attempt of the respiratory
system to decrease acidosis and counteract the effects of ketone buildup.

 Option C: Blurred vision occurs when an increase in blood glucose levels causes
changes in retinal blood vessels causing them to swell up.

 Options D: Increased urination or polyuria is an attempt of the body to excrete

excess glucose produced by the liver (gluconeogenesis). Diuresis induced by
hyperglycemia, dehydration, hyperosmolarity, and electrolyte imbalance results in a
decrease in glomerular filtration.

 Option E: Increased thirst (polydipsia) occurs due to increased urination. DKA usually
develops slowly. But when vomiting occurs, this life-threatening condition can
develop in a few hours. Early symptoms include thirst or a very dry mouth.

 Option F: DKA causes alterations in blood glucose levels which may result in fatigue.
Altered blood glucose metabolism may result in acute and chronic hyperglycemic
episodes, hypoglycemia, or blood glucose fluctuations.

 Option G: DKA is caused by a deficiency in insulin. Without insulin, the amount of

glucose entering the cells is reduced causing hyperglycemia and not hypoglycemia.

 Option H: Excess glucose in the body causes the kidneys to excrete glucose along
with water and electrolytes. This causes excessive urination leading to dehydration.
Patients with DKA can lose up to 7 liters of water over a 24 hour period.

 Option I: DKA is characterized by hyperventilation and not hypoventilation due to

the body’s attempt to decrease acidosis caused by ketone buildup.

 Option J: Due to an increase in urination, there is hyponatremia in DKA rather than

hypernatremia. Patients with DKA can lose 500 mEq of sodium, potassium, and
chloride.
  Option K: Metabolic acidosis occurs in DKA due to ketone bodies which are acids.
Their accumulation leads to metabolic acidosis and not metabolic alkalosis.

26. 1. Question
1 point(s)
A client’s blood gases reflect diabetic acidosis. The nurse
should expect:

A. Increased pH
Incorrect
B. Decreased PO2
C. Increased PCO2
D. Decreased HCO3
Correct answer
Incorrect
Correct Answer: D. Decreased HCO3
The bicarbonate-carbonic acid buffer system helps maintain
the pH of the body fluids; in metabolic acidosis, there is a
decrease in bicarbonate because of an increase of metabolic
acids. Acidosis in DKA is due to the overproduction of ?-
hydroxybutyric acid and acetoacetic acid. At physiological pH,
these 2 keto acids dissociate completely, and the excess
hydrogen ions bind the bicarbonate, resulting in decreased
serum bicarbonate levels.
 Option A: Due to carbon dioxide forming carbonic acid in
the body when combining with water, the amount of
carbon dioxide expired can cause pH to increase or
decrease. If bicarbonate is reabsorbed and/or acid is
secreted into the urine, the pH becomes more alkaline
(increases).
 Option B: If a PaO2 level is lower than 80 mmHg, it
means that a person is not getting enough oxygen. A low
PaO2 level can point to an underlying health condition,
such as emphysema. chronic obstructive pulmonary
disease, or COPD. pulmonary fibrosis.
 Option C: PaCO2 level determines respiratory
contribution; a high level means the respiratory system is
lowering the pH and vice versa. Due to carbon dioxide
forming carbonic acid in the body when combining with
water, the amount of carbon dioxide expired can cause
pH to increase or decrease.
27. 2. Question
1 point(s)
The nurse knows that glucagon may be given in the treatment
of hypoglycemia because it:
 A. Inhibits gluconeogenesis
B. Stimulates the release of insulin
Incorrect
C. Increases blood glucose levels
Correct answer
D. Provides more storage of glucose.
Incorrect
Correct Answer: C. Increases blood glucose levels
Glucagon, an insulin antagonist produced by the alpha cells in
the islets of Langerhans, leads to the conversion of glycogen to
glucose in the liver. Glucagon is a polypeptide hormone
commonly used in the treatment of severe hypoglycemia with
FDA approval for the treatment of severe hypoglycemia and as
a diagnostic aid in imaging of the GI tract.
 Option A: Glucagon binds G-coupled surface receptors
found throughout the body in varying concentrations;
binding to the glucagon receptors in the liver, GI tract,
heart, pancreas, fat, adrenal glands, and kidneys activate
adenylate cyclase, which in turn raises cAMP levels. cAMP
stimulates glycogenolysis and gluconeogenesis, resulting
in the release of glucose, primarily from liver glycogen
stores.
 Option B: Insulin secretion is governed by the
interaction of nutrients, hormones, and the autonomic
nervous system. Glucose, as well as certain other sugars
metabolized by islets, stimulates insulin release.
 Option D: Glucose is the main source of fuel for our
cells. When the body doesn’t need to use glucose for
energy, it stores it in the liver and muscles. This stored
form of glucose is made up of many connected glucose
molecules and is called glycogen.
28. 3. Question
1 point(s)
A client with type 1 diabetes mellitus has a fingerstick glucose
level of 258mg/dl at bedtime. An order for sliding scale insulin
exists. The nurse should:

A. Call the physician

B. Encourage the intake of fluids
Incorrect
C. Administer the insulin as ordered
Correct answer
D. Give the client 1/2 c. of orange juice
Incorrect
Correct Answer: C. Administer the insulin as ordered
 A value of 258 mg/dl is above the expected range of 70-105
mg/dl; the nurse should administer the insulin as ordered.
Sliding scale regimens may include a bedtime high blood sugar
correction. As the nighttime scale only considers the amount of
insulin required to drop the blood sugar level back into the
target range, it should not be used to cover a bedtime snack.
 Option A: It is unnecessary to call the physician. The
term “sliding scale” refers to the progressive increase in
the pre-meal or nighttime insulin dose, based on
predefined blood glucose ranges. Sliding scale insulin
regimens approximate daily insulin requirements.
 Option B: When using a sliding scale, eat the same
amount of carbohydrates at each meal. In other words,
while the foods may change, the time and the
carbohydrate content of the meal should not vary. Eat
the pre-assigned amount of carbohydrate for each meal,
and at a similar time of the day.
 Option D: The sliding scale method does not
accommodate changes in insulin needs related to snacks
or to stress and activity. The sliding scale method may
seem easier because there are fewer calculations.
However, to be successful, it requires strict adherence to
a consistent schedule of meals and activity and following
the prescribed diet.
29. 4. Question
1 point(s)
The physician orders 36 units of NPH and 12 units of regular
insulin. The nurse plans to administer these drugs using one
(1) syringe.

Tip: Identify the steps in this procedure by listing them

in priority order, simply drag and drop the choices
below.

View Answers:

Reorder
Invert NPH vial and withdraw NPH dose
answer isIncorrect
Reorder
Inject air equal to regular dose into regular dose
answer isCorrect
Reorder
Inject air equal to NPH dose into NPH vial
 answer isIncorrect
Reorder
Invert regular insulin bottle and withdraw regular insulin
dose
answer isIncorrect
Incorrect
The correct order of answers is shown above.
A short-acting (regular insulin) and intermediate-acting insulin
(NPH) are compatible. They can be mixed by drawing the
regular insulin first followed by the NPH. In order to properly
resuspend the insulin, vials should be carefully rolled between
the palms of the hands several times. When mixing insulin NPH
with other preparations of insulin (eg, insulin aspart, insulin
glulisine, insulin lispro, insulin regular), insulin NPH should be
drawn into the syringe after the other insulin preparations.
After mixing NPH with regular insulin, the formulation should
be used immediately.
30. 5. Question
1 point(s)
The nurse is teaching a client regarding the administration of
insulin as part of the discharge plan. Which of the following
insulin has the most rapid onset of action?

A. insulin regular (Humulin R)

B. lispro (Admelog)
Correct
C. glargine (Toujeo)
D. insulin NPH (Humulin N)
Correct
Correct Answer: B. Lispro (Admelog)
Lispro is a rapid-acting insulin that works within 15 minutes
after injection, a peak of 30-90 minutes, and a duration of 2-4
hours. Insulin lispro is a rapid-acting, human insulin analog that
works parenterally to lower blood glucose by regulating the
metabolism of carbohydrates, proteins, and fats. It works by
binding to a glycoprotein receptor specific to insulin on the
surface of target cells.
 Option A: Human regular (Humulin R) is a regular or
short-acting insulin that usually reaches the bloodstream
in 30 minutes, a peak of 2-3 hours, and a duration of 3 to
6 hours. Regular insulin, a short-acting human insulin, is
a synthetic protein hormone, which, just as the naturally
occurring endogenous insulin, exerts a wide range of
physiologic effects.
  Option C: Glargine (Toujeo) is ultra-long-acting insulin
that reaches the bloodstream within 6 hours, has no
peak, and duration 36 hours or longer. Insulin glargine is
a long-acting insulin injected once daily and provides a
basal level of insulin throughout the day. Regimens often
combine it with rapid-acting insulin to obtain optimal
glycemic control.
 Option D: Insulin NPH (Humulin N) is an intermediate-
acting insulin that reaches the bloodstream about 2 to 4
hours after injection, a peak of 4-12 hours, and duration
of 12-18 hours. NPH insulin is an isophane suspension of
human insulin and is categorized as an intermediate-
acting insulin. It helps increase the cellular intake of
glucose in the liver, adipose tissue, and skeletal muscles.
31. 6. Question
1 point(s)
A client with diabetes mellitus states, “I cannot eat big meals; I
prefer to snack throughout the day.” The nurse should
carefully explain that:

A. Regulated food intake is basic to control

Correct answer
B. Salt and sugar restriction is the main concern
C. Small, frequent meals are better for digestion
Incorrect
D. Large meals can contribute to a weight problem
Incorrect
Correct Answer: A. Regulated food intake is basic to
control
An understanding of the diet is imperative for compliance. A
balance of carbohydrates, proteins, and fats usually
apportioned over three main meals and two between meals
snacks need to be tailored to the client’s specific needs, with
due regard for activity, diet, and therapy.
 Option B: Many people with diabetes also have
dyslipidemia and hypertension, making reductions in
dietary intake of saturated fat, cholesterol, and sodium
desirable. Therefore, the emphasis of nutrition therapy
for type 2 diabetes is on lifestyle strategies to reduce
glycemia, dyslipidemia, and blood pressure.
 Option C: Division of food intake, three meals or smaller
meals and snacks, should be based on individual
preferences. Treatment with insulin or insulin
secretagogues requires consistency in timing of meals
and carbohydrate content.
  Option D: Carbohydrate and monounsaturated fat
together should provide 60–70% of energy intake.
However, the metabolic profile and need for weight loss
should be considered when determining the
monounsaturated fat content of the diet.
32. 7. Question
1 point(s)
A client with diabetes mellitus has an above-knee amputation
because of severe peripheral vascular disease, Two days
following surgery, when preparing the client for dinner, it is the
nurse’s primary responsibility to:

A. Check the client’s serum glucose level

Correct answer
B. Assist the client out of bed to the chair
C. Place the client in a High-Fowler's position
Incorrect
D. Ensure that the client’s residual limb is elevated
Incorrect
Correct Answer: A. Check the client’s serum glucose
level
Because the client has diabetes, it is essential that the blood
glucose level is determined before meals to evaluate the
success of control of diabetes and the possible need for insulin
coverage. Integrating CGMs as part of a glycemic control
protocol can lead to better management of glucose levels with
fewer hyperglycemia episodes and lower glucose level
variability resulting in better post-surgical outcome.
 Option B: Physical therapy will begin soon after surgery
when the client’s condition is stable and the doctor clears
the client for rehabilitation. The first 2 to 3 days of
treatment may include gentle stretching and range-of-
motion exercises, learning to roll in bed, sit on the side of
the bed, and move safely to a chair.
 Option C: In clients who have undergone transtibial and
transfemoral amputations, prolonged sitting with the hip
and knee flexed should be avoided. Clients who have
undergone transfemoral amputations should be
instructed to lie in the prone position multiple times
during the day to stretch the hip musculature.
 Option D: Elevate the stump for the first 24 to 48 hours.
Move and turn the client gently and slowly to prevent
severe muscle spasms. Reposition the client every 2
hours, turning the patient from side to side and prone, if
possible.
33. 8. Question
1 point(s)
Which of the following nursing interventions should be taken
for a client who complains of nausea and vomits one hour after
taking his glyburide (DiaBeta)?

A. Give glyburide again

B. Give subcutaneous insulin and monitor blood glucose
C. Monitor blood glucose closely, and look for signs of
hypoglycemia
Correct
D. Monitor blood glucose, and assess for signs of
hyperglycemia
Correct
Correct Answer: C. Monitor blood glucose closely, and
look for signs of hypoglycemia.
When a client who has taken an oral antidiabetic agent vomits,
the nurse would monitor glucose and assess him frequently for
signs of hypoglycemia. As rates for hypoglycemia can be
higher with glyburide than other oral antidiabetic agents, close
monitoring for signs and symptoms of declining blood glucose
levels is required.
 Option A: Most of the medication has probably been
absorbed. Therefore, repeating the dose would further
lower glucose levels later in the day. It is necessary to
monitor glyburide patients even further if they are in
circumstances that provoke the onset of hypoglycemia:
this includes exercise, lack of eating, and accidental
overdosage.
 Option B: Giving insulin would also lower the glucose
levels, causing hypoglycemia. Knowledge of the signs
and symptoms of hypoglycemia is vital when starting a
patient on glyburide and self-monitoring of blood glucose
and regularly scheduled testing of blood glucose and
HbA1C as recommended by the ADA.
 Option D: The client wouldn’t have hyperglycemia if the
glyburide was absorbed. Glyburide toxicity is most likely
to result from severe hypoglycemia from an excessive
dosage, whether accidentally or intentionally. Drug-drug
interactions with glyburide and other sulfonylureas due to
duplicate metabolism through the CYP2C9 enzyme can
also potentiate hypoglycemia.
34. 9. Question
1 point(s)
Which of the following chronic complications is associated with
diabetes?

A. Dizziness, dyspnea on exertion, and coronary artery

disease
B. Retinopathy, neuropathy, and coronary artery disease
Correct answer
C. Leg ulcers, cerebral ischemic events, and pulmonary
infarcts
Incorrect
D. Fatigue, nausea, vomiting, muscle weakness, and cardiac
arrhythmias
Incorrect
Correct Answer: B. Retinopathy, neuropathy, and
coronary artery disease
These are all chronic complications of diabetes. Regardless of
the specific type of diabetes, complications involve
microvascular, macrovascular, and neuropathic issues.
Microvascular and macrovascular complications vary according
to the degree and the duration of poorly controlled diabetes
and include nephropathy, retinopathy, neuropathy, and ASCVD
events, especially if it is associated with other comorbidities
like dyslipidemia and hypertension.
 Option A: Dizziness, dyspnea on exertion, and coronary
artery disease are symptoms of aortic valve stenosis. The
acquired aortic stenosis manifests with exertional
dyspnea, syncope, angina, and, ultimately, heart failure.
Angina results from the combination of the need for
increased oxygen in hypertrophied myocardium and
reduction of oxygen delivery secondary to the excessive
compression of coronary vessels.
 Option C: Leg ulcers, cerebral ischemic events, and
pulmonary infarcts are complications of sickle cell
anemia. Approximately 2.5% of patients with SCA above
10 years of age have leg ulcers. Chronic hemolysis leads
to pulmonary vascular changes classified under WHO
group 1 in up to 10% of all SCA patients. PAH in SCA can
also occur due to left heart dysfunction (Group II), chronic
lung disease from SCA (Group III), chronic
thromboembolism (Group IV), or extrathoracic causes
(Group V).
 Option D: Fatigue, nausea, vomiting, muscle weakness,
and cardiac arrhythmias are symptoms of
hyperparathyroidism. Physical examination findings are
usually noncontributory. Examination may reveal muscle
weakness and depression. A palpable neck mass is not
 usually expected with hyperparathyroidism, although in
rare cases, it may indicate parathyroid cancer.
35. 10. Question
1 point(s)
Rotating injection sites when administering insulin prevents
which of the following complications?

A. Insulin edema
B. Insulin lipodystrophy
Correct answer
C. Insulin resistance
Incorrect
D. Systemic allergic reactions
Incorrect
Correct Answer: B. Insulin lipodystrophy
Insulin lipodystrophy produces fatty masses at the injection
sites, causing unpredictable absorption of insulin injected into
these sites. Lipodystrophy is associated with increased
glycemic variability and unexplained episodes of hypoglycemia
further driving up healthcare costs while affecting patient
compliance. Studies have shown that the correct rotation
technique of insulin sites has the strongest protective value in
preventing lipohypertrophy.
 Option A: Peripheral or generalized edema is an
extremely rare complication of insulin therapy, which
mostly occurs after the initiation of intensive insulin
therapy. Despite the essential role of insulin therapy in
the management of patients with insulin deficiency,
insulin itself may lead to adverse effects such as
hypoglycemia and weight gain. Additionally, crucial fluid
retention can also occur rarely, resulting in an edematous
condition.
 Option C: Insulin resistance is identified as an impaired
biologic response to insulin stimulation of target tissues,
primarily the liver, muscle, and adipose tissue. Insulin
resistance impairs glucose disposal, resulting in a
compensatory increase in beta-cell insulin production and
hyperinsulinemia.
 Option D: Hypoglycemia is, by far, the most common
adverse effect of insulin therapy. The other adverse
effects of insulin therapy include weight gain and rarely
electrolyte disturbances like hypokalemia, especially
when used along with other drugs causing hypokalemia.
36. 11. Question
 1 point(s)
Which of the following methods of insulin administration would
be used in the initial treatment of hyperglycemia in a client
with diabetic ketoacidosis?

A. Subcutaneous
B. Intramuscular
C. IV bolus only
Incorrect
D. IV bolus, followed by continuous infusion
Correct answer
Incorrect
Correct Answer: D. IV bolus, followed by continuous
infusion.
An IV bolus of insulin is given initially to control the
hyperglycemia; followed by a continuous infusion, titrated to
control blood glucose. Previous treatment protocols have
recommended the administration of an initial bolus of 0.1 U/kg,
followed by the infusion of 0.1 U/kg/h. A more recent
prospective randomized trial demonstrated that a bolus is not
necessary if patients are given hourly insulin infusion at 0.14
U/kg/hr.
 Option A: After the client is stabilized, subcutaneous
insulin is given. Treatment of adult patients who have
uncomplicated, mild diabetic ketoacidosis can be treated
with subcutaneous insulin lispro hourly in a non-intensive
care setting may be safe and cost-effective as opposed to
treatment with intravenous regular insulin in the
intensive care setting as shown in many studies.
 Option B: Insulin is never given intramuscularly. In one
of these studies, the patients received subcutaneous
insulin lispro at a dose of 0.3 U/kg initially, followed by
0.1 U/kg every hour until blood glucose was less than 250
mg/dl. Then insulin dose was decreased to 0.05 or 0.1
U/kg given every hour until the resolution of DKA.
 Option C: Intravenous insulin by continuous infusion is
the standard of care. When the plasma glucose reaches
200-250 mg/dl, and if the patient still has an anion gap,
then dextrose-containing fluids should be initiated, and
the insulin infusion rate may need to be reduced.
37. 12. Question
1 point(s)
Insulin forces which of the following electrolytes out of the
plasma and into the cells?
 A. Calcium
B. Magnesium
C. Phosphorus
Incorrect
D. Potassium
Correct answer
Incorrect
Correct Answer: D. Potassium
Insulin forces potassium out of the plasma, back into the cells,
causing hypokalemia. Potassium is needed to help transport
glucose and insulin into the cells. Insulin shifts potassium into
cells by stimulating the activity of Na+-H+ antiporter on cell
membrane, promoting the entry of sodium into cells, which
leads to activation of the Na+-K+ ATPase, causing an
electrogenic influx of potassium. IV insulin leads to a dose-
dependent decline in serum potassium levels
 Option A: When levels of blood sugar, or glucose, rise, it
is efficiently taken up by beta-cells. Within the cells,
glucose initiates a chain of molecular events that lead to
calcium channel opening, allowing more calcium ions to
flow into the beta-cells. Calcium ions stimulate insulin
release to the blood.
 Option B: Magnesium has an important role in insulin
action, and insulin stimulates magnesium uptake in
insulin-sensitive tissues. Impaired biological responses to
insulin are referred to as insulin resistance.
 Option C: A rise in insulin causes phosphate to move to
the intracellular compartment. Additionally, the increased
anabolism leads to the formation of high-energy
phosphate bonds, further depleting phosphate levels.
38. 13. Question
1 point(s)
Which of the following causes of Hyperglycaemic Hyperosmolar
Non-Ketotic Syndrome (HHNS) is most common?

A. Insulin overdose
B. Removal of the adrenal gland
C. Undiagnosed, untreated hyperpituitarism
Incorrect
D. Undiagnosed, untreated diabetes mellitus
Correct answer
Incorrect
Correct Answer: D. Undiagnosed, untreated diabetes
mellitus
 Undiagnosed, untreated diabetes mellitus is one of the most
common causes of HHNS. Hyperosmolar hyperglycemic
syndrome (HHS) is a clinical condition that arises from a
complication of diabetes mellitus. Type 2 diabetes accounts for
about 90% to 95% of diabetes cases. It is most commonly seen
in patients with obesity. If diabetes mellitus is well controlled,
the chance of developing HHS is minimal.
 Option A: Insulin overdose can cause toxicity by causing
hypoglycemia and many additional effects, including
arrhythmias, coma, seizures, hypotension, amongst other
symptoms. Long-term insulin use may lead to dermal
toxicity by causing lipodystrophy.
 Option B: Primary adrenal insufficiency occurs after
bilateral adrenalectomy. Signs and symptoms are volume
depletion, hypotension, hyponatremia, hyperkalemia,
fever, abdominal pain. Other consequences of bilateral
adrenalectomy include hypercortisolism due to excess
ACTH stimulation of residual adrenal tissue, adrenal
crisis, and the development of an aggressive corticotropic
tumor called Nelson’s syndrome.
 Option C: Hyperpituitarism can cause several different
conditions. These conditions include Cushing syndrome,
gigantism or acromegaly, galactorrhea or prolactinoma,
and hyperthyroidism.
39. 14. Question
1 point(s)
A client is in diabetic ketoacidosis (DKA) secondary to infection.
As the condition progresses, which of the following symptoms
might the nurse see?

A. Kussmaul’s respirations and a fruity odor on the breath

Correct answer
B. Shallow respirations and severe abdominal pain
C. Decreased respiration and increased urine output
Incorrect
D. Cheyne-stokes respirations and foul-smelling urine
Incorrect
Correct Answer: A. Kussmaul’s respirations and a fruity
odor on the breath
Coma and severe acidosis are ushered in with Kussmaul’s
respirations (very deep but not labored respirations) and a
fruity odor on the breath. Kussmaul’s breathing, which is
labored, deep, and tachypneic, may occur. Some providers
may appreciate a fruity scent to the patient’s breath, indicative
of the presence of acetone.
  Option B: The patient with diabetic ketoacidosis may
present with a myriad of symptoms and physical exam
findings. Patients may have symptoms of hyperglycemia
like polyphagia, polyuria, or polydipsia. If there is a
superimposed infection that triggered the episode of
DKA, the patient may have other infectious symptoms
like fever, cough, or other urinary symptoms.
 Option C: As patients become more volume-depleted,
they may experience decreased urine output, dry mouth,
or decreased sweating indicative of dehydration. They
may complain of many other symptoms, including
anorexia, nausea, vomiting, abdominal pain, and weight
loss.
 Option D: On examination, vital signs typically reveal
tachycardia and tachypnea. Due to the possibility of an
infectious trigger for DKA, the patient may be febrile or
hypothermic. Blood pressure may also vary, though
hypotension is possible and indicative of a more severe
disease process.
40. 15. Question
1 point(s)
Clients with type 1 diabetes may require which of the following
changes to their daily routine during periods of infection?

A. No changes
B. Less insulin
C. More insulin
Correct
D. Oral antidiabetic agents
Correct
Correct Answer: C. More insulin
During periods of infection or illness, diabetics may need even
more insulin to compensate for increased blood glucose levels.
During illness, it is important that insulin be continued even if
the patient is unable to eat or is vomiting.
 Option A: The appropriate insulin dosage is dependent
on the glycemic response of the individual to food intake
and exercise regimens. A dosage algorithm suited to the
individual’s needs and treatment goals should be
developed with the cooperation of the patient.
 Option B: Rapid-acting insulin analogs should be
injected within 15 min before a meal or immediately after
a meal. The most commonly recommended interval
between injection of short-acting (regular) insulin and a
meal is 30 min.
  Option D: Healthcare practitioners must encourage
patients to combine lifestyle modifications with oral
pharmacologic agents for optimal glycemic control,
particularly as type 2 diabetes mellitus progresses with
continued loss of pancreatic beta-cell function and insulin
production.
41. 16. Question
1 point(s)
Marlisa has been diagnosed with diabetes mellitus type 1. She
asks Nurse Errol what this means. What is the best response
by the nurse? Select all that apply.

A. "Your alpha cells should be able to secrete insulin, but

cannot."
B. "The exocrine function of your pancreas is to secrete
insulin."
C. "Without insulin, you will develop ketoacidosis (DKA)."
Correct
D. "The endocrine function of your pancreas is to secrete
insulin."
Correct answer
E. "It means your pancreas cannot secrete insulin."
Correct answer
Incorrect
Correct Answer: C, D, & E
One function of your pancreas is to secrete insulin. The
endocrine function of the pancreas is to secrete insulin. A
consequence of diabetes mellitus type 1 is that without insulin,
severe metabolic disturbances, such as ketoacidosis (DKA) will
result.
 Option A: Insulin is secreted by the beta, not the alpha,
cells of the pancreas. Insulin synthesis occurs in the beta
cells of the pancreas initially as preproinsulin.
Preproinsulin then converts to proinsulin, which then
transforms into a single peptide with A, B, and C peptide
units.
 Option B: The pancreas contains exocrine glands that
produce enzymes important to digestion. These enzymes
include trypsin and chymotrypsin to digest proteins;
amylase for the digestion of carbohydrates; and lipase to
break down fats.
 Option C: Insulin deficiency and increased
counterregulatory hormones also lead to the release of
free fatty acids into circulation from adipose tissue
(lipolysis), which undergo hepatic fatty acid oxidation to
 ketone bodies (beta-hydroxybutyrate and acetoacetate),
resulting in ketonemia and metabolic acidosis.
 Option D: The endocrine, not the exocrine, function of
the pancreas is to secrete insulin. The endocrine
component of the pancreas consists of islet cells (islets of
Langerhans) that create and release important hormones
directly into the bloodstream. Two of the main pancreatic
hormones are insulin, which acts to lower blood sugar,
and glucagon, which acts to raise blood sugar.
 Option E: Three mechanisms lead to islet cell
destruction: genetic susceptibility, autoimmunity, and
environmental insult(s). A virus or allergen
(environmental insults) in genetically susceptible
individuals induces the production of autoantibodies to
Beta cells of the islets of the pancreas. This autoimmune
reaction creates autoreactive T cells that destroy beta-
islet cells and cause loss of insulin secretion.
42. 17. Question
1 point(s)
Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with
a blood sugar of 563. Nurse AJ administers insulin lispro
(Humalog) intravenously (IV). What does the best evaluation
of the nurse reveal? Select all that apply.

A. The nurse could have given the insulin subcutaneously.

B. The nurse should have contacted the physician.
Correct answer
C. The nurse should have used regular insulin (Humulin R).
Correct
D. The nurse used the correct insulin.
E. The nurse could have given the insulin intramuscularly.
Incorrect
Correct Answer: B & C.
Insulin lispro is an insulin analog that is FDA-approved for the
treatment of patients with diabetes mellitus types 1 and 2 to
control hyperglycemia. Regular insulin, short-acting human
insulin, is a synthetic protein hormone, which, just as the
naturally occurring endogenous insulin, exerts a wide range of
physiologic effects.
 Option A: The nurse cannot give the insulin
subcutaneously when it is ordered to be given
intravenously (IV). Insulin, regular when administered
subcutaneously, should be injected 30 to 40 minutes
before each meal.
  Option B: Contact the provider to clarify the order,
regular insulin is the only insulin that can be given
intravenously (IV). When administered intravenously, U-
100 administration should be with close monitoring of
serum potassium and blood glucose. Do not use it if the
solution is viscous or cloudy; administration should only
occur if it is colorless and clear.
 Option C: Regular insulin is the only insulin that can be
given intravenously (IV). The nurse did not use correct
insulin as it was not regular insulin. Incorrect
administration of insulin (e.g., too little, too much, or at
wrong times) can result in transient and serious hypo-
and hyperglycemia, wide glycemic excursions, and
diabetic ketoacidosis.
 Option D: The insulin ordered by the physician was an
intravenous infusion. For intravenous infusions, to
minimize insulin adsorption to plastic IV tubing, flush the
intravenous tube with a priming infusion of 20 mL from a
100 mL-polyvinyl chloride bag insulin every time a new
intravenous tubing is added to the insulin infusion
container.
 Option E: Insulin may be injected into the subcutaneous
tissue of the upper arm and the anterior and lateral
aspects of the thigh, buttocks, and abdomen (with the
exception of a circle with a 2-inch radius around the
navel). Intramuscular injection is not recommended for
routine injections.
43. 18. Question
1 point(s)
Ben injects his insulin as prescribed, but then gets busy and
forgets to eat. What will the best assessment of the nurse
reveal?

A. The client will be very thirsty.

B. The client will complain of nausea.
C. The client will need to urinate.
Incorrect
D. The client will have moist clammy skin.
Correct answer
Incorrect
Correct Answer: D. The client will have moist clammy
skin.
Moist skin is the sign of hypoglycemia, which the client would
experience if he injected himself with insulin and did not eat.
 “Insulin shock” is a common term for low blood sugar, or
hypoglycemia. It may also be called an insulin reaction.
 Option A: Excessive thirst may be a symptom of high
blood sugar (hyperglycemia). It’s important to be able to
recognize any imbalance in thirst or urine production. It’s
the function of the kidneys and other organs to help filter
out impurities.
 Option B: As the blood glucose levels rise and fall, the
body’s metabolism can get interrupted and confused
which can lead to a mixed feeling of nausea.
 Option C: Polyuria due to a glucose-induced osmotic
diuresis is common in patients with hyperglycemia. This
diuresis usually abates when the plasma glucose level
approaches its renal threshold; the usual time course is
less than 8 hours after commencing therapy.
44. 19. Question
1 point(s)
A clinical instructor teaches a class for the public about
diabetes mellitus. Which individual does the nurse assess as
being at the highest risk for developing diabetes?

A. The 50-year-old client who does not get any physical

exercise
B. The 56-year-old client who drinks three glasses of wine
each evening
C. The 42-year-old client who is 50 pounds overweight
Correct
D. The 38-year-old client who smokes one pack of cigarettes
per day
Correct
Correct Answer: C. The 42-year-old client who is 50
pounds overweight
Obesity increases the likelihood of developing diabetes
mellitus due to the overstimulation of the endocrine system.
Obesity is believed to account for 80-85% of the risk of
developing type 2 diabetes, while recent research suggests
that obese people are up to 80 times more likely to develop
type 2 diabetes than those with a BMI of less than 22.
 Option A: Exercise is important, but lack of exercise is
not as big a risk factor as obesity. Scientists in the United
States have found that not taking part in much physical
activity could be the primary cause of chronic conditions,
including diabetes, obesity, and fatty liver disease, and
also that taking regular exercise may not actually help
people who are sedentary.
  Option B: Consuming alcohol is associated with liver
disease but is not as high a risk factor for diabetes as
obesity. While moderate amounts of alcohol may cause
blood sugar to rise, excess alcohol can actually decrease
the blood sugar level — sometimes causing it to drop into
dangerous levels, especially for people with type 1
diabetes. Beer and sweet wine contain carbohydrates
and may raise blood sugar.
 Option D: Smoking is a serious health concern but is not
a specific risk factor for diabetes. Smokers are 30 to 40
percent more likely to develop type 2 diabetes than
nonsmokers. Smoking can also make managing the
disease and regulating insulin levels more difficult
because high levels of nicotine can lessen the
effectiveness of insulin, causing smokers to need more
insulin to regulate blood sugar levels.
45. 20. Question
1 point(s)
A patient was recently diagnosed with type 1 diabetes mellitus
and received insulin. Which laboratory test will the nurse
assess?

A. Potassium
Correct answer
B. AST (aspartate aminotransferase)
C. Serum amylase
Incorrect
D. Sodium
Incorrect
Correct Answer: A. Potassium
Insulin causes potassium to move into the cell and may cause
hypokalemia. Insulin shifts potassium into cells by stimulating
the activity of Na+-H+ antiporter on cell membrane, promoting
the entry of sodium into cells, which leads to activation of the
Na+-K+ ATPase, causing an electrogenic influx of potassium.
IV insulin leads to a dose-dependent decline in serum
potassium levels
 Option B: In type 2 diabetes, in the absence of
detectable steatosis by ultrasonography, ALT and AST are
associated with hyperinsulinemia and insulin resistance,
independent of obesity. This finding possibly indicates
that in diabetes a mild stage of steatosis is sufficient to
mediate the association between insulin resistance and
aminotransferases.
  Option C: Insulin can minimally affect amylase activity.
People with diabetes whose insulin-secreting beta cells in
the pancreas are working well have higher amylase levels
(within the normal range). Animal studies show that
insulin increases amylase production
 Option D: The primary action of insulin on sodium
balance is exerted on the kidney. Increases in plasma
insulin concentration within the physiological range
stimulate sodium reabsorption by the distal nephron
segments and this effect is independent of changes in
circulating metabolites or other hormones.
46. 21. Question
1 point(s)
Jansen is receiving metformin (Glucophage). What will be
the best plan of the nurse with regard to patient education
with this drug? Select all that apply.

A. It stimulates the pancreas to produce more insulin.

B. It must be taken with meals.
Correct answer
C. It decreases sugar production in the liver.
Correct answer
D. It inhibits the absorption of carbohydrates.
Incorrect
E. It reduces insulin resistance.
Correct answer
Incorrect
Correct Answer: B, C, & E.
Metformin (Glucophage) reduces insulin resistance, decreases
sugar production in the liver, and should be taken with meals
for the best absorption and effect. Metformin, FDA-approved in
1994, is an antidiabetic agent used in type 2 diabetes mellitus.
Metformin comes in both immediate-release and extended-
release and is available in several combination products with
other antidiabetic agents.
 Option A: It does not stimulate the pancreas to produce
more insulin. Insulin secretion is governed by the
interaction of nutrients, hormones, and the autonomic
nervous system. Glucose, as well as certain other sugars
metabolized by islets, stimulates insulin release.
 Option B: Metformin is an oral medication typically
dosed from 500 to 2550 mg per day and administered
with a meal to decrease GI upset. The daily dose is often
titrated weekly in increments of 500 mg or 850 mg to
reduce this risk.
  Option C: Metformin is a biguanide drug that reduces
blood glucose levels by decreasing glucose production in
the liver, decreasing intestinal absorption, and increasing
insulin sensitivity. Metformin decreases both basal and
postprandial blood glucose.
 Option D: It does not inhibit the absorption of
carbohydrates. Two alpha-glucosidase inhibitors,
acarbose and voglibose, slow carbohydrate absorption
and reduce postprandial glucose levels by inhibiting the
alpha-glucosidase enzymes on the brush border of the
small intestine.
 Option E: Metformin, the most widely-prescribed insulin-
sensitizing agent in current clinical use, improves blood
glucose control mainly by improving insulin-mediated
suppression of hepatic glucose production, and by
enhancing insulin-stimulated glucose disposal in skeletal
muscle.
47. 22. Question
1 point(s)
Serafica who has diabetes mellitus type 1 is found
unresponsive in the clinical setting. Which nursing action is a
priority?

TIP: To arrange all answers in the correct order, simply

drag and drop the choices below.

View Answers:

Reorder
Assess the vital signs.
answer isIncorrect
Reorder
Call the physician STAT.
answer isCorrect
Reorder
Treat the client for hypoglycemia.
answer isIncorrect
Reorder
Call a code.
answer isCorrect
Incorrect
The correct order of answers is shown above.
 1. When a patient with diabetes mellitus type 1 is
unresponsive, the nurse should focus on the treatment of
 hypoglycemia, as this is more likely than hyperglycemia.
If hypoglycemia causes unconsciousness, or the patient is
unco-operative. Intravenous administration of 75-80 ml
20% glucose or 150-160 ml of 10% glucose (the volume
will be determined by the clinical scenario).
 2. This is an emergency situation where the nurse must
act before calling the physician. Once the patient regains
consciousness, oral glucose should be administered.
Recovery of consciousness and restoration of normal
plasma glucose levels are expected in about 10-15
minutes.
 3. Vital signs should be taken after the client is treated
for hypoglycemia. It should be noted that hyperglycemic
coma occurs progressively, usually over several hours or
even days. In contrast, hypoglycemia evolves within a
few minutes. In addition, in contrast to marked
hyperglycemia, in hypoglycemia the skin is wet, deep
tendon reflexes are increased, and there is mydriasis.
 4. Assessment for Airway, Breathing, and Circulation
(ABC) should precede calling a code; there is no
information that the client is not breathing.
48. 23. Question
1 point(s)
Serge who has diabetes mellitus is taking oral agents and is
scheduled for a diagnostic test that requires him to be NPO.
What is the best plan of the nurse with regard to giving the
client his oral medications?

A. Administer the oral agents immediately after the test.

B. Notify the diagnostic department and request orders.
C. Notify the physician and request orders.
Correct
D. Administer the oral agents with a sip of water before the
test.
Correct
Correct Answer: C. Notify the physician and request
orders.
It is best to notify the client’s physician and request orders.
After a period of fasting (“nil per os,” NPO), oral antidiabetic
drugs should be resumed only when the patient eats the first
normal-sized meal. Special recommendations are in effect for
metformin and sulfonylureas.
 Option A: The medications should not be given upon
return unless the physician orders this; the client may
still need to be NPO. Metformin, according to the
 manufacturer’s instructions, should be stopped 48 hours
before the intended procedure and resumed only when
the patient is reliably tolerating oral food intake, as long
as there are no other contraindications
 Option B: The radiologist in the diagnostic department
might give orders, but it would be best to check with the
client’s physician first. As the use of iodinated
radiological contrast media can temporarily lower the
glomerular filtration rate, potentially inducing renal
failure, metformin should be discontinued at least 24
hours before the radiological study and restarted no
sooner than 48 hours afterward, and only if laboratory
tests confirm normal renal function.
 Option D: The client should not receive the medication
during NPO status unless directed by the physician. When
oral antidiabetic agents are temporarily discontinued,
insulin can be given: the blood glucose concentration can
be controlled either with subcutaneous insulin injections
or with intravenous insulin through a perfusor pump,
depending on the length and invasiveness of the
procedure.
49. 24. Question
1 point(s)
A client diagnosed with type 1 diabetes receives insulin. He
asks the nurse why he can’t just take pills instead. What is
the best response by the nurse?

A. "Insulin must be injected because it needs to work quickly."

B. "Insulin can't be in a pill because it is destroyed in stomach
acid."
Correct answer
C. "Have you talked to your doctor about taking pills instead?"
Incorrect
D. "I know it is tough, but you will get used to the shots soon."
Incorrect
Correct Answer: B. “Insulin can’t be in a pill because it
is destroyed in stomach acid.”
Insulin must be injected because it is destroyed in the stomach
acid if taken orally. Insulin is a particularly difficult drug to
ingest orally. It is a protein that degrades in the stomach and
small intestine, making it almost impossible to design oral
delivery which works.
 Option A: The onset of insulin action is not the issue
here. Insulin delivery via the stomach would transport the
 much-needed hormone directly to the liver, where it
could mimic the action of endogenous insulin.
 Option C: The nurse should answer the client’s question,
not refer him back to the physician. At this stage, insulin
remains too complex a protein to survive within the
environment of the body. Leading pharmaceutical
companies are thought to be using protein engineering to
bring the insulin pull one step closer.
 Option D: Telling he will get used to shots does not
answer his question and is condescending. Giving
diabetes patients the chance to avoid the pain of needles
has been the goal of many pharmaceutical companies for
many years.
50. 25. Question
1 point(s)
Nurse Andy has finished teaching a client with diabetes
mellitus how to administer insulin. He evaluates the learning
has occurred when the client makes which statement?

A. "I should check my blood sugar immediately prior to the

administration."
B. "I should provide direct pressure over the site following the
injection."
C. "I should use the abdominal area only for insulin injections."
Incorrect
D. "I should only use a calibrated insulin syringe for the
injections."
Correct answer
Incorrect
Correct Answer: D. “I should only use a calibrated
insulin syringe for the injections.”
To ensure the correct insulin dose, a calibrated insulin syringe
must be used. Insulin syringes are used only to deliver units of
insulin. To decrease dosage error, insulin syringes are
calibrated in units and not milliliters. Insulin syringes are
available in three sizes: 100 unit (1 mL), 50 unit (0.5 mL), and
30 unit (0.3 mL)
 Option A: There is no need to check blood glucose
immediately prior to the injection. Testing is usually
recommended before meals and at bedtime if taking
multiple daily injections. You may need to test only
before breakfast and dinner if you use just an
intermediate- or long-acting insulin.
 Option B: There is no need to apply direct pressure over
the site following an insulin injection. After the dose has
 been injected, hold the needle in for a good 10 seconds
to help insulin get delivered and prevent any of the dose
from escaping out.
 Option C: Insulin injections should be rotated to the arm
and thigh, not just the abdominal area. Each of the main
four areas (abdomen, buttocks, outer thighs, and upper
arms) should give a good area of flesh to inject into.
Using different areas of the body to inject into is insulin
injection site rotation.
Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she
likes to have a glass of wine with dinner. What will the best plan of the nurse for client education
include?

A. The alcohol could cause pancreatic disease.

B. The alcohol could cause serious liver disease.

C. The alcohol could predispose you to hypoglycemia.

Correct

D. The alcohol could predispose you to hyperglycemia.

Correct

Correct Answer: C. The alcohol could predispose you to hypoglycemia.

Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client. When the client drinks
alcohol, the alcohol can inhibit the liver’s ability to release glucose into the blood. This can be
particularly significant for people on stronger medication such as insulin because it can mean that
the liver is not able to release enough glycogen to keep the blood glucose levels from going too low
under the influence of insulin in the body.

 Option A: Alcohol can cause pancreatic disease, but the client’s pancreas is not producing
any insulin currently. Alcohol abuse is a well-recognized association of both acute and
chronic pancreatitis, with repeated attacks of alcohol-induced acute pancreatic
necroinflammation leading to chronic disease. The risk of developing pancreatitis increases
with increased consumption of alcohol.

 Option B: Alcohol can cause liver disease, but the more immediate concern is hypoglycemia.
Moderate amounts of alcohol may cause blood sugar to rise, excess alcohol can actually
decrease your blood sugar level – which can be dangerous for people with T1D.

 Option D: People with T1D should only drink while eating food. Beer and sweet wine contain
carbohydrates and may raise blood sugar. People may overeat when drinking alcohol which
also can increase your BG.

6. Question

During a visit to 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
Correct answer

B. A woman who is at 90% of standard body weight after delivering an eight-pound baby

Incorrect

C. A middle-aged Caucasian male

D. An older client who is hypotensive

Incorrect

Correct 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 bodyweight, 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.

 Option B: The American Diabetes Association (ADA) recommends opportunistic screening of

adults of any age with a body mass index ?25 kg/m2 and additional risk factors, which
include physical inactivity, a first-degree relative with diabetes, high-risk race/ethnicity, etc.

 Option C: Prevalence of diagnosed diabetes was highest among American Indians/Alaska

Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%),
followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%).

 Option D: Postural hypotension occurs when something interrupts this natural response,
such as dehydration, which is a common problem for people with less well-controlled
diabetes as a result of frequent urination.

7. Question

A client was brought to the emergency room with complaints of slurring of speech, vomiting, dry
mucosa, and dry skin turgor. Lab tests showing serum sodium 125 mEq/L and serum blood glucose of
350 mg/dL. Nurse Sophie will anticipate the physician to initially order which of the following
intravenous solutions?

A. 10% dextrose in water (D10W)

B. 0.9% normal saline solution

Correct answer

C. 5% dextrose in water (D5W)

Incorrect

D. 0.45% normal saline solution

Incorrect

Correct Answer: B. 0.9% normal saline solution

The client is experiencing diabetic ketoacidosis. Initial priority in the treatment is to restore the
extracellular fluid volume through the intravenous administration of 0.9% normal saline at 15-20
ml/kg/h. Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and
to clear ketones. Hydration improves glycemic control independent of insulin.

 Options A and C: Intravenous solutions containing dextrose will be given once serum glucose
reaches 250 mg/dL. When the plasma glucose reaches 200-250 mg/dl, and if the patient still
has an anion gap, then dextrose-containing fluids should be initiated, and the insulin infusion
rate may need to be reduced.

 Option D: 0.45% normal saline will be given once serum sodium stabilizes. In patients who
have high serum sodium levels, 0.45% NaCl infused at 4–14 ml/kg/hour or 250–500 mL/hr is
appropriate, and for patients with hyponatremia, 0.9% NaCl at a similar rate is preferred.

8. Question

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 attacks 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

Incorrect

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 the development of
hypoglycemia

Correct answer

D. Aspirin and alcohol will cause the stomach to bleed more when on a sulfonylurea drug

Incorrect

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

Alcohol lowers blood glucose levels and disrupts the production of glucose in the liver. Sulfonylureas,
when taken with alcohol, may produce a disulfiram-like reaction which may lead to flushing,
hypotension, nausea, tachycardia, vertigo, and blurred vision. Metformin should be avoided in
patients with a history of chronic alcohol use because they may be more predisposed to lactic
acidosis.

 Option A: Insulin and oral hypoglycemics mixed with alcohol may increase the risk of
hypoglycemic reactions. Chlorpropamide and possibly other sulfonylureas may produce a
disulfiram-like reaction with alcohol, leading to flushing, hypotension, nausea, tachycardia,
vertigo, dyspnea, and blurred vision.

 Option B: The use of aspirin for the prevention of cardiovascular events, regardless of the
dose, in patients with diabetes mellitus type II receiving sulfonylureas alone or in
combination with other antidiabetic tablets, may increase the risk of hypoglycemia.
  Option D: Alcohol suppresses gluconeogenesis, which may increase the risk for
hypoglycemia in diabetic patients. The risk is further increased if the patient uses insulin or
oral hypoglycemics. For patients on sulfonylureas, the literature suggests an increased risk of
hypoglycemia, especially with the longer-acting first-generation sulfonylureas (tolbutamide
and chlorpropamide). There may also be increased risk in second-generation sulfonylureas.

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 1 diabetes.”

B. “It has a higher mortality rate than diabetic ketoacidosis.”

Correct

C. “The client with HHNS is in a state of overhydration.”

D. “This condition develops very rapidly.”

Correct

Correct Answer: B. “It has a higher mortality rate than diabetic ketoacidosis.”

It is a medical emergency and has a higher mortality rate than Diabetic Ketoacidosis. The mortality
rate in HHS can be as high as 20% which is about 10 times higher than the mortality seen in diabetic
ketoacidosis. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute
metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2
diabetes mellitus.

 Option A: Hyperglycemic Hyperosmolar Nonketotic Syndrome occurs only in people with

type 2 diabetes. Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that
arises from a complication of diabetes mellitus. Type 2 diabetes accounts for about 90% to
95% of diabetes cases. It is most commonly seen in patients with obesity.

 Option C: As a consequence of obesity and high body mass index (BMI), there is the
resistance of the peripheral tissue to the action of insulin. The beta-cell in the pancreas
continues to produce insulin, but the amount is not enough to counter the effect of the
resistance of the end organ to its effect. HHS is a serious and potentially fatal complication of
type 2 diabetes.

 Option D: This condition develops very slowly over hours or days. HHS has similar
pathophysiology to DKA but with some mild dissimilarities. The hallmark of both conditions
is the deficiency of insulin. As a consequence of deficiency of this key hormone, there is a
decrease in glucose utilization by the peripheral tissue causing hyperglycemia.

10. Question

The nurse is conducting a teaching session for a 25-year-old underweight and emaciated client with
newly diagnosed type 1 diabetes mellitus. The client lives alone and is anxious about managing their
condition, particularly self-administering insulin injections. Considering the client’s physical condition
and concerns, which is the most appropriate technique for self-administering insulin injections from
the following options:

A. Instruct the client to pinch the skin up and use a 90-degree angle for insulin injection.
 B. Advise the client to use a 45-degree angle with the skin pinched up during insulin injection.

Correct

C. Teach the client to massage the area of injection after injecting the insulin to promote absorption.

D. Recommend warming the skin with a warm towel or washcloth prior to the injection to improve
circulation.

Correct

Correct Answer: B. Use a 45-degree angle with the skin pinched up

For an underweight and emaciated client, using a 45-degree angle with the skin pinched up helps to
ensure the insulin is injected into the subcutaneous tissue rather than the muscle. This method
promotes proper absorption of insulin and reduces the risk of injection site complications.

 Option A: This technique is appropriate for clients with an average or above-average body
weight, as it ensures the insulin is injected into the subcutaneous tissue.

 Option C: Massaging the injection site is not recommended as it may increase the rate of
insulin absorption leading to potential hypoglycemia.

 Option D: Warming the skin can lead to faster absorption rates and inconsistent insulin
absorption.

12. Question

Blood sugar is well controlled when Hemoglobin A1C is:

A. Below 5.7%

Correct answer

B. Between 12%-15%

Incorrect

C. Less than 180 mg/dL

D. Between 90 and 130 mg/dL

Incorrect

Correct Answer: A. Below 5.7%

HbA1c measures the percentage of hemoglobin that is glycated and determines average blood
glucose during the 2 to 3 months prior to testing. A1C of 6% to 6.5% is considered prediabetes.
Tighter control is shown by levels of HbA1c in the 7% range or lower, were correlated with a 35-76%
decrease in microvascular complications, like retinopathy, nephropathy, and neuropathy, in patients
with type 1 diabetes.

 Option B: Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate
diabetes. Anyone with an HbA1c value of 5.7 % to 6.4 % is considered to be prediabetic,
while diabetes can be diagnosed with an HbA1c of 6.5% or higher.

 Option C: Patients who are at the borderline of these criteria for diabetes are considered
prediabetic. The ADA criteria define prediabetes as impaired fasting glucose (IFG) defined as
 fasting plasma glucose of 100 mg/dL to 125 mg/dL or impaired glucose tolerance (IGT) 2-
hour plasma glucose (in OGTT) of 140 mg/dL to 199 mg/dL or A1c of 5.7 to 6.4%.

 Option D: Normal plasma glucose levels are defined as under 100 mg/dL during fasting and
less than 140 mg/dL 2-hours postprandial. Additionally, glucose levels in healthy individuals
can vary with age. Fasting plasma glucose in adults tends to increase with age starting in the
third decade of life but does not increase significantly beyond 60 years of age.

 13. Question
Which of the following diabetes drugs acts by decreasing the
amount of glucose produced by the liver?

A. Alpha-glucosidase inhibitors
B. Biguanides
Correct
C. Meglitinides
D. Sulfonylureas
Correct
Correct Answer: B. Biguanides
Biguanides, such as metformin, lower blood glucose by
reducing the amount of glucose produced by the liver.
Metformin is a biguanide drug that reduces blood glucose
levels by decreasing glucose production in the liver,
decreasing intestinal absorption, and increasing insulin
sensitivity.
 Option A: Alpha-glucosidase inhibitors block the
breakdown of starches and some sugars, which helps to
reduce blood glucose levels. Alpha-glucosidase inhibitors
competitively inhibit alpha-glucosidase enzymes in the
intestinal brush border cells that digest the dietary
starch, thus inhibiting the polysaccharide reabsorption
and the metabolism of sucrose to glucose and fructose.
 Option C: Meglitinides exert their effects via different
pancreatic beta-cell receptors, but they act similarly to
sulfonylureas by regulating adenosine triphosphate-
sensitive potassium channels in pancreatic beta cells,
thereby causing an increase in insulin secretion.
 Option D: Sulfonylureas bind to adenosine triphosphate-
sensitive potassium channels (K-ATP channels) in the
beta cells of the pancreas; this leads to the inhibition of
those channels and alters the resting membrane
potential of the cell, causing an influx of calcium and the
stimulation of insulin secretion.
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14. Question

A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells
the nurse he has type 1 diabetes mellitus. Which of the following actions should the nurse do first?

A. Inject 1 mg of glucagon subcutaneously

B. Administer 50 mL of 50% glucose I.V

Incorrect

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

Correct answer

D. Give the client four to six glucose tablets

Incorrect

Correct 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,
or 1 tablespoon of sugar.

 Option A: For patients unable to take oral agents, a 1-mg intramuscular (IM) injection of
glucagon can be administered. Glucagon can have variable absorption, as it is given SC or IM.
It has a relatively slow onset of action and relies on glycogen stores. Therefore, it may not be
effective in cachectic patients, those with liver disease, and in young children.
  Option B: Severe hypoglycemia can be treated with intravenous (IV) dextrose followed by
infusion of glucose. Intravenous administration of 75-80 ml 20% glucose or 150-160 ml of
10% glucose (the volume will be determined by the clinical scenario).

 Option D: The nurse may also give two to three glucose tablets for a hypoglycemic reaction.
Essentially, a quick-acting carbohydrate needs to be given, followed by a longer-acting
carbohydrate.

16. Question

A medication nurse is about to give insulin to a patient with diabetes mellitus. Upon reviewing the
medications of the patient, which of the following would cause a further decrease in the blood
glucose level of the patient?

A. hydrochlorothiazide (Microzide)

B. levothyroxine (Synthroid)

Incorrect

C. carvedilol (Coreg)

Correct answer

D. hydrocortisone (SoluCortef)

Incorrect

Correct Answer: C. carvedilol (Coreg)

Carvedilol (Coreg) is a beta-blocker when given together with insulin would cause an increased
hypoglycemic effect of insulin, resulting in a further decrease in the serum blood glucose level.
Carvedilol has hyperglycemic potential when given orally for 5 days in normal albino rats. Though it
may be beneficial in diabetics for various comorbid conditions, the glycemic control may worsen
during its use in subjects with prediabetes, diabetes, high risk diabetes.

 Option A: Thiazide antihypertensive drugs (e.g., hydrochlorothiazide) and thiazide-like drugs

(e.g., metolazone) are often prescribed to control blood pressure in people with diabetes.
Thiazide diuretics are known to promote hyperglycemia and in some cases contribute to the
new onset of diabetes.

 Option B: It is likely that glucose levels will stabilize during hypothyroidism treatment. But
when thyroid function is normalized, this may lead to higher blood glucose levels and
adverse effects on glycemic control.

 Option D: Hydrocortisone-induced hyperglycemia and it is possible that continuous

hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight
blood glucose control could be better achieved with this approach.

18. Question

A nurse is caring for a client admitted with diabetic retinopathy. Which of the following would the
nurse expect to note on the assessment of this client:

A. Blurred or distorted vision

 B. Flashes of lights or floaters

Incorrect

C. Sudden loss of vision

D. All of the above

Correct answer

Incorrect

Correct Answer: D. All of the above

Diabetic retinopathy is a complication of diabetes that is characterized by chronic and progressive

damage to the retina. Symptoms include blurring of vision (due to macular edema), flashes of lights,
and sudden loss of vision (due to retinal detachment).

 Option A: Over time, diabetes damages small blood vessels throughout the body, including
the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other
fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision.

 Option B: The abnormal blood vessels associated with diabetic retinopathy stimulate the
growth of scar tissue, which can pull the retina away from the back of the eye. This can cause
spots floating in the vision, flashes of light, or severe vision loss.

 Option C: Diabetic retinopathy is a complication of diabetes, caused by high blood sugar

levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and
untreated.