DM NCLEX PRACTICE

The nurse is coaching a diabetic client using an empowerment approach. The nurse should initiate teaching by asking which questions?

1. "How much does your family need to be involved in learning about your condition?"

2. "What is required for your family to manage your symptoms?"

3. "What activities are most important for you to be able to maintain control of your diabetes?"

4."What do you know about your medications and condition?"

3. "What activities are most important for you to be able to maintain control of your diabetes?"

The nurse is obtaining a health history from a client with diabetes mellitus who has been taking insulin for 20 years. Currently, the client reports having periods of hypoglycaemia followed by periods of hyperglycaemia. What should the nurse ask about the client's current management plan?

Is the client:

1. eating snacks between meals?

2. using an insulin pump?

3. injecting insulin at a site of lipodystrophy?

4. adjusting insulin according to blood glucose levels?

3. injecting insulin at a site of lipodystrophy?

A nurse is participating in a diabetes screening program. Which clients are at risk for developing type 2 diabetes? Select all that apply.

1. a 32-year-old female who gave birth to a 9.5 lb infant

2. a 44-year-old Native American who has a BMI of 32

3. an 18-year-old immigrant from Mexico who jogs four times a week

4. a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes

5. a 12-year-old who is overweight

1. a 32-year-old female who gave birth to a 9.5 lb infant

2. a 44-year-old Native American who has a BMI of 32

4. a 55-year-old Asian who has hypertension and two siblings with type 2 diabetes

5. a 12-year-old who is overweight

An adult with type 2 diabetes mellitus has been NPO since 2200 in preparation for having a nephrectomy the next day. At 0600 on the day of surgery, the nurse reviews the client's medical record and laboratory results. Which finding should the nurse report to the health care provider?

1. urine output of 350 mL in 8 hours

2. urine specific gravity of 1.015

3. potassium of 4.0 mEq (4 mmol/L)

4. blood glucose of 140 mg/dL (7.8 mmol/L)

4. blood glucose of 140 mg/dL (7.8 mmol/L)

A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss?

1. hypotension

2. decreased serum potassium level

3. rapid, deep respirations

4. warm, dry skin

3. rapid, deep respirations

A client is to received glargine insulin in addition to a dose of apart. When the nurse checks the blood glucose level at the bedside, it is >200 mg/dL (11.1 mmol/L). How should the nurse administer the insulins?

1. Put air into the glargine insulin vial and then air into the apart insulin vial, draw up the correct dose of aspart insulin first.

2. Roll the glargine insulin vial, and then roll the apart insulin vial. Draw up the longer-acting glargine insulin first.

3. Shake both bills of insulin before drawing up each dose in separate insulin syringes.

4. Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe, then with a different insulin syringe, put air into the asaprt vial, and draw up the correct dose.

4. Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe, then with a different insulin syringe, put air into the asaprt vial, and draw up the correct dose.

The client with type 2 insulin-requiring diabetes asks the nurse about having alcoholic beverages. Which is the best response by the nurse?

1. "You can have one or two drinks a day as long as you have something to eat with them"

2. "Alcohol is detoxified in the liver, so it's not a good idea for you to drink anything with alcohol."

3. "If you are going to have a drink, it's best to consume alcohol on an empty stomach."

4. "If you do have a drink, the blood glucose value may be elevated at bedtime, an you should skip having a snack."

1. "You can have one or two drinks a day as long as you have something to eat with them"

An adult with type 2 diabetes is taking metformin 1000 mg two times every day. The client asks the nurse about having an alcoholic drink. Which statement indicates the client understands the interaction of alcohol and metformin?

1. "If I know I'll be having alcohol, I shouldn't take metformin."

2. "If my health care provider approves, I may drink alcohol with my metformin."

3. "Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain, and a rapid heartbeat."

4. "If I feel bloated, I should call my health care provider."

1. "If I know I'll be having alcohol, I shouldn't take metformin."

Before supper, an adult client who has type-2 diabetes and requires insulin tells the nurse about having tremors, being weak and anxious. What should the nurse do next?

1. Tell the client to lie down for 30 minutes

2. Have the client drink a glass of milk or orange juice

3. Contact the client's HCP to decrease the insulin dose

4. Administer the next dose of insulin

2. Have the client drink a glass of milk or orange juice

The HCP has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. What should the nurse teach the client about this insulin?

1. "You may increase the carbohydrates in your diet when using insulin"

2. "You do not need to rotate injection sites with this insulin"

3. "You do not mix insulin deter, the solution is clear"

4. "You may refill the detemir insulin pen"

3. "You do not mix insulin deter, the solution is clear"

When evaluating teaching a client how to administer insulin, which action indicates that additional teaching is necessary?

The client:

1. draws up the regular insulin first and then the NPH.

2. rotates sites from arms to legs

3. identifies that the syringe is U-100

4. waits 30 minutes to eat breakfast after injecting rapid-acting insulin

4. waits 30 minutes to eat breakfast after injecting rapid-acting insulin

A client with newly diagnosed type 1 diabetes is scheduled to receive regular insulin 10 unites and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications?

1. regular insulin with breakfast; NPH after breakfast

2. both insulins 0.5 hours before breakfast

3. in two separate syringes with breakfast

4. NPH 1 hour before and regular 0.5 hours before breakfast

2. both insulins 0.5 hours before breakfast

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? Select all that apply.

1. A major risk factor for complications is obesity and central abdominal obesity.

2. Supplemental insulin is mandatory for controlling the disease

3. Exercise increases insulin resistance

4. The primary nutritional source requiring monitoring in the diet is carbohydrates

5. Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations

1. A major risk factor for complications is obesity and central abdominal obesity.

5. Annual eye and foot examinations are recommended by the American and Canadian Diabetes Associations

When teaching a diabetic client about foot care, what should the nurse instruct the client to do?

1. Avoid going barefoot

2. Buy shoes a half size larger

3. Cut toenails at angles

4. Use heating pads for sore feet

1. Avoid going barefoot

A client with diabetes mellitus asks the nurse to recommend something to remove corns from the toes. What should the nurse advise the client to do?

1. Apply a high-quality corn plaster to the area

2. Consult a health care provider about removing the corns

3. Apply iodine to the corns before peeling them off

4. soak the feet in borax solution to peel of the corns

2. Consult a health care provider about removing the corns

A client with diabetes mellitus presents to the clinic for a regular 3-month follow-up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, "I'm so clumsy, I'm always cutting my finger cooking or burning myself on the iron." Which response by the nurse would be most appropriate?

1. "Wash all wounds in isopropyl alcohol."

2. "Keep all cuts clean and covered."

3. "Could you have your children do the cooking and ironing?"

4. "You really should be fine as long as you take your daily medication."

2. "Keep all cuts clean and covered."

The client with diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." The nurse should base the response to this comment on the knowledge that diabetes affects metabolism of which nutrients?

1. carbohydrates only

2. fats and carbohydrates only

3. protein and carbohydrates only

4. proteins, fats, and carbohydrates

4. proteins, fats, and carbohydrates

A client with type 1 diabetes mellitus is admitted to the emergency department. Which respiratory pattern in a client with diabetes mellitus requires immediate attention?

1. deep, rapid respirations with long expirations

2. shallow respirations alternating with long expirations

3. regular depth of respirations with frequent pauses

4. short expirations and inspirations

1. deep, rapid respirations with long expirations

The client has been recently diagnosed with type 2 diabetes and is taking metformin two times per day, 1000 mg before breakfast and 1000 mg before supper. The client is experiencing diarrhea, nausea, vomiting, abdominal bloating, and anorexia on admission to the hospital. The admission prescriptions include metformin. What should the nurse do? Select all that apply.

1. Discontinue the metformin

2. Administer glargine insulin rather than the metformin

3. Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually subside over time.

4. Assess the client's renal function

5. Monitor the client's glucose value prior to each meal

3. Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually subside over time.

4. Assess the client's renal function

5. Monitor the client's glucose value prior to each meal

A client is to use an insulin pen. Which action indicates the client is using the pen correctly? Select all that apply.

1. stores the unopened pens in the refridgerator

2. injects the insulin in sites around the abdomen

3. primes the pen by expelling any air

4. massages the site after injection

5. saves needle for reuse

1. stores the unopened pens in the refridgerator

2. injects the insulin in sites around the abdomen

3. primes the pen by expelling any air

A client with type 2 insulin-requiring diabetes has the flu with nausea, body aches, and lack of appetite. The client's blood sugar is 180 mg/dL (10 mmol/L). The vital signs are temperature 38.3 C, pulse 88 bpm, respirations 20 breaths per minute. What should the nurse instruct the client to do? Select all that apply.

1. stop taking insulin

2. check blood sugar every 4 hours

3. drink 240 mL fluids every hour

4. check urine for ketones

5. take two 325 mg aspirin

2. check blood sugar every 4 hours

3. drink 240 mL fluids every hour

To reduce the risk of developing type 2 diabetes mellitus, what should the nurse instruct the client to do?

1. stop smoking cigarettes

2. obtain a high-cholesterol diet

3. maintain weight in normal limits

4. prevent hypertension

3. maintain weight in normal limits

The nurse is teaching the client about home blood glucose monitoring. Which blood glucose measurement indicates hypoglycaemia?

1. 59 mg/dL (3.3 mmol/L)

2. 75 mg/dL (4.2 mmol/L)

3. 108 mg/dL (6 mmol/L)

4. 119 mg/dL (6.6 mmol/L)

1. 59 mg/dL (3.3 mmol/L)

The client with type 1 diabetes mellitus is taught to take isoprene insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk of hypoglycaemia will occur at about what time?

1. 1100, shortly before lunch

2. 1300, shortly after lunch

3. 1800, shortly after dinner

4. 0100, while sleeping

4. 0100, while sleeping

A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs?

1. arms

2. legs

3. abdomen

4. iliac crest

3. abdomen

A client with diabetes is taking insulin lispro injections. At what time should the nurse advise the client to eat?

1. within 10 to 15 minutes after the injection

2. 1 hour after the injection

3. at any time because timing of meals with lisper injections is unnecessary

4. 2 hours before the injection

1. within 10 to 15 minutes after the injection

The nurse has instructed a client newly diagnosed with diabetes how to self-inject insulin. Which is the best indicator that the client has learned how to give an insulin self-injection correctly?

The client can't:

1. perform the procedure safely and correctly

2. critique the nurse's performance of the procedure

3. explain all steps of the procedure correctly

4. obtain 100% correct answers on a posttest

1. perform the procedure safely and correctly

The nurse should teach the diabetic client that which symptom is most indicative of hypoglycaemia?

1. nervousness

2. anorexia

3. kussmaul's respirations

4. bradycardia

1. nervousness

The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes?

1. aspirin

2. steroids

3. sulfonylureas

4. angiotensin-converting enzyme (ACE) inhibitors

2. steroids

A client with type 1 diabetes mellitus has influenza. What should the nurse instruct the client to do?

1. Increase the frequency of self-monitoring (blood glucose testing)

2. reduce food intake to diminish nausea

3. discontinue that dose of insulin if unable to eat

4. take half of the normal dose of insulin

1. Increase the frequency of self-monitoring (blood glucose testing)

Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza?

1. obtaining adequate food intake

2. managing own health

3. relieving pain

4. increasing activity

1. obtaining adequate food intake

A client with diabetes begins to cry and says, "I just can't stand the though of having to give myself a shot every day." What would be the best response by the nurse?

1. "If you don't give yourself your insulin shots, you'll be at greater risk for complications."

2. "We can teach a family member to give the shots so you won't have to do it."

3. "I can arrange to have a home care nurse give you the shots every day."

4. "What is it about giving yourself the insulin shots that bothers you?"

4. "What is it about giving yourself the insulin shots that bothers you?"