Ch 53 Final exam 100 practice questions

Which of the following is a primary characteristic of Diabetic Ketoacidosis (DKA)? a) Hypoglycemia b) Absence of ketones c) Profound deficiency of insulin d) Alkalosis

c) Profound deficiency of insulin

DKA is most likely to occur in individuals with which type of diabetes mellitus? a) Type 2 DM b) Type 1 DM c) Gestational DM d) Prediabetes

b) Type 1 DM

Which of the following is not a precipitating factor for DKA? a) Infection b) Adequate insulin dosage c) Undiagnosed Type 1 DM d) Severe illness

b) Adequate insulin dosage

In DKA, the body burns which fuel source due to insulin deficiency? a) Carbohydrates b) Proteins c) Fats d) Glycogen

c) Fats

What is the by-product of fat metabolism that alters pH in DKA, leading to metabolic acidosis? a) Lactic acid b) Urea c) Ketones d) Bicarbonat

c) Ketones

Severe depletion of which electrolytes can occur in untreated DKA? a) Chloride, magnesium, phosphate, calcium b) Sodium, potassium, calcium, glucose c) Sodium, potassium, chloride, magnesium, phosphate d) Iron, zinc, copper, selenium

c) Sodium, potassium, chloride, magnesium, phosphate

Which type of respiration is a clinical manifestation of DKA? a) Cheyne-Stokes respirations b) Biot's respirations c) Kussmaul respirations d) Apneustic respirations

c) Kussmaul respirations

What is the characteristic breath odor in DKA? a) Ammonia-like b) Fishy c) Sweet, fruity d) Bitter almond

c) Sweet, fruity

A glucose level greater than or equal to what value is indicative of DKA? a) 126 mg/dL b) 200 mg/dL c) 250 mg/dL d) 300 mg/dL

c) 250 mg/dL

What is a common early clinical manifestation of DKA related to dehydration? a) Hypotension b) Bradycardia c) Moist mucous membranes d) Hypertension

d) Hypertension

When glucose levels approach 250 mg/dL during DKA treatment, what should be added to the IV fluids? a) Insulin b) Sodium bicarbonate c) 5% to 10% dextrose d) Potassium chloride

c) 5% to 10% dextrose

Before starting insulin therapy for DKA, it is crucial to monitor and replace which electrolyte due to insulin's effect on cellular uptake? a) Sodium b) Calcium c) Magnesium d) Potassium

d) Potassium

What is the target drop in serum glucose per hour during IV insulin drip for DKA to avoid complications? a) 10 to 20 mg/dL/hr b) 25 to 35 mg/dL/hr c) 36 to 54 mg/dL/hr d) 60 to 75 mg/dL/hr

c) 36 to 54 mg/dL/hr

Which of the following is not a factor for hospitalization in DKA management? a) Severe fluid and electrolyte imbalance b) Mild nausea and vomiting c) Altered mental state d) Fever

b) Mild nausea and vomiting

What type of fluid resuscitation is typically initiated first in emergency DKA management? a) Dextrose 5% in water b) Lactated Ringer's solution c) NaCl 0.45% or 0.9% d) Colloids

c) NaCl 0.45% or 0.9%

Hyperosmolar Hyperglycemic Syndrome (HHS) is most common in individuals with which type of diabetes, typically over what age? a) Type 1 DM, over 40 years b) Type 2 DM, over 60 years c) Gestational DM, any age d) Prediabetes, over 50 years

b) Type 2 DM, over 60 years

In HHS, patients are able to make enough insulin to prevent which condition, distinguishing it from DKA? a) Hypoglycemia b) Metabolic alkalosis c) Ketoacidosis d) Osmotic diuresis

c) Ketoacidosis

Which of the following is a common cause of HHS? a) Insulin overdose b) Excessive alcohol intake c) Urinary tract infections (UTIs) d) Autoimmune destruction of pancreatic cells

c) Urinary tract infections (UTIs)

Which manifestation is more severe in HHS compared to DKA, due to increased serum osmolality? a) Abdominal pain b) Kussmaul respirations c) Neurologic manifestations d) Fruity breath odor

Neurologic manifestations

What is the typical glucose level seen in HHS, often higher than in DKA? a) Greater than 250 mg/dL b) Greater than 400 mg/dL c) Greater than 600 mg/dL d) Greater than 800 mg/dL

c) Greater than 600 mg/dL

Which lab finding is typically absent or minimal in blood and urine in HHS, unlike DKA? a) Glucose b) Ketones c) Sodium d) Potassium

b) Ketones

Management of HHS is similar to DKA but requires more of which intervention? a) Insulin administration b) Fluid replacement c) Potassium monitoring d) Dextrose administration

b) Fluid replacement

What is crucial to monitor in HHS management to avoid fluid overload? a) Serum sodium levels b) Blood glucose levels c) Hemodynamic status d) Urine ketone levels

c) Hemodynamic status

Which of these can mimic a stroke in patients with HHS? a) Somnolence b) Hypokalemia c) Metabolic acidosis d) Hypotension

a) Somnolence

What is the primary precipitating factor for HHS related to fluid intake? a) Excessive fluid intake b) Inadequate fluid intake c) Rapid fluid shifts d) High-sodium diet

b) Inadequate fluid intake

HHS is described as a medical emergency with what characteristic? a) Low mortality rate b) High mortality rate c) Rapid onset d) Chronic progression

b) High mortality rate

Which condition is a common cause of HHS, often seen in older adults? a) Undiagnosed Type 1 Diabetes Mellitus b) Acute illness c) Pancreatitis d) Addison's disease

b) Acute illness

Patients with HHS have enough circulating insulin to prevent what? a) Hyperglycemia b) Osmotic diuresis c) Ketoacidosis d) Extracellular fluid depletion

c) Ketoacidosis

The impaired thirst sensation is a common cause of which condition? a) DKA b) Hypoglycemia c) HHS d) Addisonian crisis

c) HHS

What type of diabetes is HHS typically associated with? a) Type 1 Diabetes b) Type 2 Diabetes c) Gestational Diabetes d) LADA (Latent Autoimmune Diabetes in Adults)

b) Type 2 Diabetes

Hyperglycemia is defined as high blood glucose levels caused by abnormal insulin production, impaired insulin use, or both. Which acute factor can increase glucose levels? a) Hypothermia b) Physical and emotional stress c) Decreased counterregulatory hormones d) Excessive sleep

b) Physical and emotional stress

Which of the following is not one of the classic symptoms of hyperglycemia? a) Polyuria b) Polydipsia c) Polyphagia d) Polycythemia

d) Polycythemia

A patient reporting prolonged wound healing and recurrent infections might be experiencing which condition? a) Hypoglycemia b) Hyperglycemia c) Normal glucose levels d) Lactic acidosis

b) Hyperglycemia

Which diagnostic criterion for diabetes involves a fasting plasma glucose (FPG) level? a) FPG level > 100 mg/dL b) FPG level > 126 mg/dL c) FPG level > 150 mg/dL d) FPG level > 200 mg/dL

b) FPG level > 126 mg/dL

An A1C level of what value or higher is a diagnostic criterion for diabetes? a) 5.7% b) 6.0% c) 6.5% d) 7.0%

c) 6.5%

Hemoglobin A1C (HbA1c) reflects glucose levels over approximately what period? a) The past 24 hours b) The past week c) The past 2-3 months d) The past 6 months

c) The past 2-3 months

One of the management goals for hyperglycemia is to prevent acute complications. Which of the following is an acute complication of Type 1 DM related to hyperglycemia? a) Peripheral neuropathy b) Diabetic retinopathy c) Ketoacidosis (DKA) d) Nephropathy

c) Ketoacidosis (DKA)

Which of the following is a symptom of hyperglycemia? a) Sudden weight gain b) Excessive sweating c) Fatigue d) Increased concentration

c) Fatigue

A random plasma glucose level greater than what value, along with classic symptoms, is a diagnostic criterion for diabetes? a) 140 mg/dL b) 160 mg/dL c) 180 mg/dL d) 200 mg/d

d) 200 mg/dL

What is a management goal for hyperglycemia aimed at reducing long-term health issues? a) Promoting rapid weight loss b) Preventing or delaying onset and progression of long-term complications c) Achieving intermittent periods of very low blood glucose d) Eliminating all carbohydrate intake

b) Preventing or delaying onset and progression of long-term complications

What is the definition of hyperglycemia? a) Low blood glucose levels b) Normal blood glucose levels c) High blood glucose levels d) Fluctuating blood glucose levels

c) High blood glucose levels

Counterregulatory hormones can cause glucose levels to: a) Decrease b) Remain stable c) Increase d) Fluctuate unpredictably

c) Increase

Which of the following symptoms of hyperglycemia is particularly common in Type 1 Diabetes and often sudden? a) Recurrent infection b) Prolonged wound healing c) Weight loss d) Visual problems

c) Weight loss

A 2-hour plasma glucose level during an Oral Glucose Tolerance Test (OGTT) of what value or higher is a diagnostic criterion for diabetes? a) 140 mg/dL b) 180 mg/dL c) 200 mg/dL d) 250 mg/dL

c) 200 mg/dL

What is a primary management goal for hyperglycemia related to patient well-being? a) Increase pain perception b) Promote well-being c) Induce ketosis d) Encourage dehydration

b) Promote well-being

Hypoglycemia is defined as too much insulin in proportion to what in the blood? a) Protein b) Fat c) Glucose d) Sodium

c) Glucose

What is the typical glucose level that defines hypoglycemia? a) Greater than 100 mg/dL b) Less than 120 mg/dL c) Less than 70 mg/dL d) Between 70 and 100 mg/dL

c) Less than 70 mg/dL

Which of the following is a common manifestation of hypoglycemia? a) Dry skin b) Diaphoresis c) Bradycardia d) Increased appetite

b) Diaphoresis

Altered mental function in hypoglycemia, also known as "Neuroglycopenia," can mimic which condition? a) Stroke b) Alcohol intoxication c) Panic attack d) Seizure disorder

b) Alcohol intoxication

If untreated, hypoglycemia can progress to what severe outcomes? a) Hypertensive crisis b) Loss of consciousness, seizures, coma, and death c) Deep vein thrombosis d) Myocardial infarction

b) Loss of consciousness, seizures, coma, and death

What characterizes hypoglycemia unawareness? a) Patient experiences exaggerated warning signs. b) Warning signs/symptoms are absent until glucose is critically low. c) Patient intentionally ignores symptoms. d) It only occurs in newly diagnosed diabetics.

b) Warning signs/symptoms are absent until glucose is critically low.

Hypoglycemia unawareness is related to diabetes-related autonomic neuropathy and decreased secretion of what? a) Insulin b) Counterregulatory hormones c) Gastric acid d) Thyroid hormones

b) Counterregulatory hormones

Which of the following is a common cause of hypoglycemia? a) Too little insulin b) Too much food c) Delaying time of eating d) Too little exercise

c) Delaying time of eating

When a high glucose level falls too rapidly, what can occur? a) Hyperglycemia b) Symptoms of hypoglycemia c) Ketoacidosis d) Normalization of blood glucose

b) Symptoms of hypoglycemia

If a patient's glucose level is less than 70 mg/dL and they are alert, what is the first step in management based on the "Rule of 15"? a) Inject insulin b) Consume 15 g of a simple carbohydrate c) Lie down and rest d) Call emergency services

b) Consume 15 g of a simple carbohydrate

After consuming 15 g of a simple carbohydrate, when should the glucose level be rechecked? a) In 5 minutes b) In 10 minutes c) In 15 minutes d) In 30 minutes

c) In 15 minutes

Which type of food should be avoided immediately after treating hypoglycemia, as it slows glucose absorption? a) High-fiber foods b) Foods with fat c) Foods with protein d) Complex carbohydrates

b) Foods with fat

For patients not alert enough to swallow or without IV access, what can be administered for hypoglycemia? a) Oral glucose tablets b) 50% dextrose IV push c) Glucagon 1 mg IM or subcutaneously d) Oral insulin

c) Glucagon 1 mg IM or subcutaneously

When administering Glucagon, what should the nurse watch for to prevent aspiration? a) Diarrhea b) Nausea c) Rash d) Headache

b) Nausea

In which patient condition might Glucagon not be effective for treating hypoglycemia? a) Patients with Type 2 diabetes b) Patients with pre-diabetes c) Alcohol-related liver disease d) Patients with normal liver function

c) Alcohol-related liver disease

What symptom is characteristic of "Neuroglycopenia"? a) Shakiness b) Palpitations c) Difficulty speaking d) Hunger

c) Difficulty speaking

Which of the following is a physiological response activated during hypoglycemia? a) Parasympathetic nervous system b) Somatic nervous system c) Autonomic nervous system d) Central nervous system

c) Autonomic nervous system

What hormone is released by the activation of the autonomic nervous system during hypoglycemia? a) Insulin b) Glucagon c) Epinephrine d) Cortisol

c) Epinephrine

Patients at risk for hypoglycemia unawareness should aim to keep their glucose levels: a) Critically low b) Somewhat higher c) Fluctuate widely d) Consistently below 70 mg/dL

b) Somewhat higher

What is the recommendation if monitoring equipment is unavailable when a patient shows signs of hypoglycemia? a) Wait until equipment is available b) Investigate further for cause c) Treatment should be initiated d) Administer only water

c) Treatment should be initiated

Which types of insulin can be mixed in the same syringe to provide both mealtime and basal coverage? a) Long-acting and intermediate-acting b) Rapid-acting and long-acting c) Short- or rapid-acting with intermediate-acting d) All types of insulin can be mixed

c) Short- or rapid-acting with intermediate-acting

Vials and pens of insulin may be left at room temperature for up to how many weeks? a) 1 week b) 2 weeks c) 3 weeks d) 4 weeks

d) 4 weeks

Where should extra unopened insulin be stored? a) In a warm, dark cabinet b) Refrigerated c) In direct sunlight d) In the freezer

b) Refrigerated

What is the preferred method of insulin administration? a) Intramuscular (IM) injection b) Intravenous (IV) injection c) Oral administration d) Subcutaneous injection

d) Subcutaneous injection

Which injection site offers the fastest absorption of insulin? a) Thigh b) Buttock c) Arm d) Abdomen

d) Abdomen

What complication can occur if injection sites are not rotated within and between sites? a) Hyperglycemia b) Lipodystrophy c) Hypoglycemia d) Infection

b) Lipodystrophy

U100 insulin must be used with a syringe marked with what? a) U50 markings b) U100 markings c) U200 markings d) No specific markings

b) U100 markings

For extremely thin or muscular individuals, at what angle should insulin be administered? a) 30 degrees b) 45 degrees c) 60 degrees d) 90 degrees

b) 45 degrees

For self-injection at home, what is needed to cleanse the site? a) An alcohol swab b) Betadine solution c) Soap and water d) Nothing, just inject

c) Soap and water

What is an advantage of insulin pens for patients? a) They are the cheapest option. b) They offer unlimited flexible dosing. c) They are portable, convenient, compact, and discreet. d) They eliminate the need for patient education

c) They are portable, convenient, compact, and discreet.

What is the risk of administering insulin via intramuscular (IM) injection? a) Localized pain b) Hypoglycemia c) Hyperglycemia d) Skin discoloration

b) Hypoglycemia

How long can prefilled syringes containing two insulin types be stored? a) 24 hours b) 3 days c) 1 week d) 4 weeks

c) 1 week

Insulin is inactivated by which type of fluids, preventing oral administration? a) Blood fluids b) Lymphatic fluids c) Gastric fluids d) Cerebrospinal fluids

c) Gastric fluids

What should be avoided to protect insulin from becoming less effective? a) Room temperature storage b) Refrigeration c) Extreme temperatures d) Use of insulin pens

c) Extreme temperatures

What is a key consideration when patients self-mix insulin from two vials? a) The temperature of the vials b) Their visual, manual, or cognitive skills c) The brand of insulin d) The color of the insulin

b) Their visual, manual, or cognitive skills

Metformin is classified as which type of antidiabetic drug? a) Sulfonylurea b) Meglitinide c) Biguanide d) Thiazolidinedione

c) Biguanide

What is the primary use of Metformin in the treatment of Type 2 diabetes? a) Second-line treatment b) Most effective first-line treatment c) Only for severe cases d) Used only in combination therapy

b) Most effective first-line treatment

Which of the following is a mechanism of action for Metformin? a) Increases glucose production by the liver. b) Enhances insulin sensitivity. c) Decreases glucose transport. d) Stimulates insulin secretion from the pancreas.

b) Enhances insulin sensitivity.

An additional effect of Metformin beyond blood glucose control is that it may cause: a) Weight gain b) Fluid retention c) Weight loss d) Increased appetite

c) Weight loss

Under which circumstances should Metformin be withheld from a patient? a) Before beginning a new exercise regimen b) If the patient is undergoing surgery or a radiologic procedure with a contrast medium c) When the patient experiences mild hyperglycemia d) If the patient has a common cold

b) If the patient is undergoing surgery or a radiologic procedure with a contrast medium

How long before a procedure with a contrast medium should Metformin typically be withheld? a) 6-12 hours b) 12-24 hours c) 24-48 hours d) 72 hours

c) 24-48 hours

Which condition is a contraindication for Metformin use? a) Hypertension b) Type 1 diabetes c) Renal disease d) Hypothyroidism

c) Renal disease

What acute kidney injury (AKI) complication can iodine-based contrast medium cause in a patient taking Metformin? a) Renal artery stenosis b) Acute tubular necrosis c) Acute kidney injury (AKI) d) Glomerulonephritis

c) Acute kidney injury (AKI)

Excessive intake of which substance is a contraindication for Metformin use? a) Sugar b) Caffeine c) Alcohol d) Sodium

c) Alcohol

Metformin is also used in the prevention of which type of diabetes? a) Type 1 diabetes b) Gestational diabetes c) Type 2 diabetes d) Secondary diabetes

c) Type 2 diabetes

Metformin improves glucose transport by: a) Increasing glucose absorption from the gut b) Enhancing insulin sensitivity c) Decreasing glucose uptake by muscle cells d) Increasing glucose secretion

b) Enhances insulin sensitivity

When Metformin is withheld for a procedure involving contrast medium, when should it be resumed? a) Immediately after the procedure b) 24 hours after, regardless of labs c) At least 48 hours after, when serum creatinine levels are within normal limits (WNL) d) Only after a full week has passed

C ) At least 48 hours after, when serum creatinine levels are within normal limits (WNL)

Which of the following is not a listed form of Metformin? a) Immediate release b) Extended release c) Topical cream d) Liquid forms

c) Topical cream

Metformin's mechanism of action involves reducing glucose production by what organ? a) Pancreas b) Kidneys c) Liver d) Spleen

c) Liver

Lactic acidosis is a contraindication for Metformin. This condition is related to problems in which organ systems? a) Gastrointestinal and respiratory b) Renal, liver, and cardiac c) Endocrine and nervous d) Musculoskeletal and lymphatic

b) Renal, liver, and cardiac

Metformin is considered the most effective first-line treatment for what? a) All forms of diabetes b) Type 2 diabetes c) Type 1 diabetes d) Gestational diabetes

b) Type 2 diabetes

What is an important precaution regarding serum creatinine levels when Metformin is withheld for a procedure with contrast? a) Ensure they are elevated before resuming b) Ensure they are within normal limits (WNL) before resuming c) No need to check creatinine levels d) Check creatinine levels only if patient shows signs of kidney injury

b) Ensure they are within normal limits (WNL) before resuming

What is a specific contraindication for Metformin use related to liver function? a) Hepatitis A b) Jaundice c) Liver disease d) Elevated liver enzymes

c) Liver disease

Metformin aids in preventing which outcome in Type 2 Diabetes? a) Hypoglycemia b) Progression to Type 1 Diabetes c) Development of Type 2 Diabetes d) Insulin resistance

c) Development of Type 2 Diabetes

When taking Metformin, which condition would alert a nurse to a potential severe adverse effect if the patient also receives iodine-based contrast medium? a) Hyperglycemia b) Acute Kidney Injury (AKI) c) Hypothyroidism d) Hyponatremia

b) Acute Kidney Injury (AKI)