Diabetes Mellitus Te

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Sample questions from Diabetes Mellitus Te

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift in a medical-surgical unit, the nurse receives report on four clients with diabetes mellitus. Which client should the nurse assess first?

   • A.A 43-year-old with glucose of 198 mg/dL who is scheduled for discharge and needs insulin teaching
   • B.A 75-year-old with glucose of 174 mg/dL who has a clean, dry foot dressing and temperature of 37.0 C
   • C.A 52-year-old whose blood glucose is 286 mg/dL and who reports thirst, with BP 128/76 mm Hg and HR 88/min
   • D.A 67-year-old with glucose of 62 mg/dL who is awake, can swallow, and reports feeling shaky

   Rationale: The client with glucose of 62 mg/dL has symptomatic hypoglycemia, which can progress quickly and requires prompt treatment. The client is alert and able to swallow, so the nurse can initiate the facility's oral hypoglycemia protocol. Hyperglycemia with thirst, discharge teaching, and a clean foot dressing are important but are less immediately urgent given the cues provided. Prioritize acute, potentially life-threatening changes before routine care.

2. 2.In a community clinic, a 16-year-old with type 1 diabetes has glucose of 312 mg/dL, moderate urine ketones, nausea, and a respiratory rate of 26/min. The parent asks whether the clinic can wait until the scheduled appointment next week. Which action should the nurse take?

   • A.Arrange immediate evaluation in an emergency department and notify the provider
   • B.Recommend giving the usual mealtime insulin and rechecking glucose in 4 hours
   • C.Schedule an appointment with the diabetes educator for the next available day
   • D.Advise the parent to encourage fluids at home and call back if vomiting begins

   Rationale: Hyperglycemia with ketones, nausea, and tachypnea can indicate diabetic ketoacidosis and requires urgent evaluation. Giving only the usual mealtime insulin or waiting for a routine appointment could delay treatment of a metabolic emergency. Fluids at home may be part of sick-day care, but these findings are concerning enough that home monitoring alone is not appropriate. The nurse should communicate the urgency and arrange immediate emergency assessment.

3. 3.During an evening shift on a medical unit, a 72-year-old with type 2 diabetes has glucose of 48 mg/dL, diaphoresis, and new confusion. The client has an order for as-needed glucagon and has a patent IV. Which actions should the nurse take? Select all that apply.

   • A.Stay with the client and call for assistance
   • B.Recheck the blood glucose after treatment according to protocol
   • C.Give oral juice even though the client is confused
   • D.Hold all future insulin doses without contacting the provider
   • E.Document the episode and notify the provider after immediate treatment
   • F.Give the prescribed IV dextrose promptly

   Rationale: Staying with the client, obtaining help, and promptly giving prescribed IV dextrose are appropriate for severe symptomatic hypoglycemia when IV access is available. Rechecking glucose evaluates the response, and notifying the provider and documenting the event support follow-up care. Oral juice is unsafe for a confused client because of aspiration risk. Independently withholding all future insulin doses is not an appropriate substitute for reporting the event and clarifying the plan.

4. 4.In a long-term care facility, an RN is assigning care for a 78-year-old resident with type 2 diabetes, stable glucose readings, and intact cognition. Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Teach the resident how to recognize early symptoms of hypoglycemia
   • B.Assess a new area of redness on the resident's heel
   • C.Obtain the resident's capillary blood glucose before breakfast and report the result
   • D.Decide whether the resident's prescribed insulin dose should be held

   Answer and rationale are in the full material.

5. 5.A client states, 'I cannot afford my insulin and have been taking it every other day.' In a primary care clinic, the 35-year-old has glucose of 294 mg/dL, HR 92/min, and no vomiting or altered mental status. Which nursing action best addresses the immediate care-coordination need?

   • A.Document nonadherence and ask the client to return in 3 months
   • B.Contact the clinic social worker or case manager to explore affordable medication access
   • C.Recommend substituting a relative's insulin until the next appointment
   • D.Tell the client that insulin must be taken as prescribed and end the discussion

   Answer and rationale are in the full material.