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Medical Surgical Nursing 8th Edition Lewis Bucher Heitkemper Dirksen Test Bank

ISBN: 9780323065788

ISBN: 9780323290333

 

 

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Medical Surgical Nursing 8th Edition Lewis Bucher Heitkemper Dirksen Test Bank

ISBN: 9780323065788

ISBN: 9780323290333

 

 

 

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Free Nursing Test Questions:

Lewis: Medical-Surgical Nursing, 8
th
Edition
Chapter 49: Nursing Management: Diabetes Mellitus
Test Bank
MULTIPLE CHOICE
1. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what “type 2”
means in relation to diabetes. Which statement by the nurse about type 2 diabetes is
correct?
a. Insulin is not used to control blood glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Type 2 diabetes is usually diagnosed when the patient is admitted with a
hyperglycemic coma.
d. Changes in diet and exercise may be sufficient to control blood glucose levels in
type 2 diabetes.
ANS: D
For some patients, changes in lifestyle are sufficient for blood glucose control. Insulin is
frequently used for type 2 diabetes, complications are equally severe as for type 1
diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after
a patient develops complications such as frequent yeast infections.
DIF: Cognitive Level: Comprehension REF: 1221-1222
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120
mg/dL (6.7 mmol/L
). The nurse will plan to teach the patient about
a. self-monitoring of blood glucose.
b. use of low doses of regular insulin.
c. lifestyle changes to lower blood glucose.
d. effects of oral hypoglycemic medications.
ANS: C
The patient’s impaired fasting glucose indicates prediabetes and the patient should be
counseled about lifestyle changes to prevent the development of type 2 diabetes. The
patient with prediabetes does not require insulin or the oral hypoglycemics for glucose
control and does not need to self-monitor blood glucose.
DIF: Cognitive Level: Application
REF: 1221
TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
3. Which action by a type 1 diabetic patient indicates that the nurse should implement
teaching about exercise and glucose control?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when the glucose is 200 mg/dL.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-2
c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine.
ANS: D
When the patient is ketotic, exercise may result in an increase in blood glucose level.
Type 1 diabetic patients should be taught to avoid exercise when ketosis is present. The
other statements are correct.
DIF: Cognitive Level: Application
REF: 1233
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
4. When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which
question is most appropriate for the nurse to ask?
a. “Have you lost any weight lately?”
b. “How long have you felt anorexic?”
c. “Is your urine unusually dark colored?”
d. “Do you crave fluids containing sugar?”
ANS: A
Weight loss occurs because the body is no longer able to absorb glucose and starts to
break down protein and fat for energy. The patient is thirsty but does not necessarily
crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes.
With the classic symptom of polyuria, urine will be very dilute.
DIF: Cognitive Level: Application
REF: 1222
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
5. To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is
scheduled for a follow-up visit in the clinic, which test will the nurse plan to schedule for
the patient?
a. Urine dipstick for glucose
b. Oral glucose tolerance test
c. Fasting blood glucose level
d. Glycosylated hemoglobin level
ANS: D
The glycosylated hemoglobin (Hb A1C
) test shows the overall control of glucose over 90
to 120 days. A fasting blood level indicates only the glucose level at one time. Urine
glucose testing is not an accurate reflection of blood glucose level and does not reflect the
glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose
diabetes, but is not used for monitoring glucose control once diabetes has been
diagnosed.
DIF: Cognitive Level: Application
REF: 1223
TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-3
6. A patient who has just been diagnosed with type 2 diabetes has a nursing diagnosis of
imbalanced nutrition: more than body requirements. Which patient goal is most important
for this patient?
a. The patient will have a glycosylated hemoglobin level of less than 7%.
b. The patient will have a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet.
ANS: A
The complications of diabetes are related to elevated blood glucose, and the most
important patient outcome is the reduction of glucose to near-normal levels. The other
outcomes also are appropriate but are not as high in priority.
DIF: Cognitive Level: Application
REF: 1223
TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
7. A patient who has type 1 diabetes plans to take a swimming class daily at 1:00 PM. The
clinic nurse will plan to teach the patient to
a. check glucose level before, during, and after swimming.
b. delay eating the noon meal until after the swimming class.
c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
d. time the morning insulin injection so that the peak occurs while swimming.
ANS: A
The change in exercise will affect blood glucose, and the patient will need to monitor
glucose carefully to determine the need for changes in diet and insulin administration.
Because exercise tends to decrease blood glucose, patients are advised to eat before
exercising. Increasing the morning NPH or timing the insulin to peak during exercise
may lead to hypoglycemia, especially with the increased exercise.
DIF: Cognitive Level: Application
REF: 1233
TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
8. An 18-year-old with newly diagnosed type 1 diabetes has received diet instruction. The
nurse determines a need for additional instruction when the patient says,
a. “I may have an occasional alcoholic drink if I include it in my meal plan.”
b. “I will need a bedtime snack because I take an evening dose of NPH insulin.”
c. “I may eat whatever I want, as long as I use enough insulin to cover the calories.”
d. “I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia.”
ANS: C
Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who
are using intensified insulin therapy have considerable flexibility in diet choices but still
should restrict dietary intake of items such as fat, protein, and alcohol. The other patient
statements are correct and indicate good understanding of the diet instruction.
DIF: Cognitive Level: Application
REF: 1230-1233 TOP: Nursing Process:
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-4
Evaluation
MSC: NCLEX: Physiological Integrity
9. Which action is most important for the nurse to take in order to assist a diabetic patient to
engage in moderate daily exercise?
a. Remind the patient that exercise will improve self-esteem.
b. Determine what type of exercise activities the patient enjoys.
c. Give the patient a list of activities that are moderate in intensity.
d. Teach the patient about the effects of exercise on glucose level.
ANS: B
Since consistency with exercise is important, assessment for the types of exercise that the
patient finds enjoyable is the most important action by the nurse in ensuring adherence to
an exercise program. The other actions also will be implemented, but are not the most
important in improving compliance.
DIF: Cognitive Level: Application
REF: 1233
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
10. The nurse has been teaching the patient to administer a dose of 10 units of regular insulin
and 28 units of NPH insulin. The statement by the patient that indicates a need for
additional instruction is,
a. “I need to rotate injection sites among my arms, legs, and abdomen each day.”
b. “I will buy the 0.5 mL syringes because the line markings will be easier to see.”
c. “I should draw up the regular insulin first after injecting air into the NPH bottle.”
d. “I do not need to aspirate the plunger to check for blood before injecting insulin.”
ANS: A
Rotating sites is no longer recommended because there is more consistent insulin
absorption when the same site is used consistently. The other patient statements are
accurate and indicate that no additional instruction is needed.
DIF: Cognitive Level: Application
REF: 1226-1227 TOP: Nursing Process:
Evaluation
MSC: NCLEX: Health Promotion and Maintenance
11. After the nurse has finished teaching a patient about self-administration of the prescribed
aspart (NovoLog
) insulin, which patient action indicates good understanding of the
teaching?
a. The patient avoids injecting the insulin into the upper abdominal area.
b. The patient cleans the skin with soap and water before insulin administration.
c. The patient places the insulin back in the freezer after administering the prescribed
insulin dose.
d. The patient pushes the plunger down and immediately removes the syringe from
the injection site.
ANS: B
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-5
Cleaning the skin with soap and water or with alcohol is acceptable. Insulin should not be
frozen. The patient should leave the syringe in place for about 5 seconds after injection to
be sure that all the insulin has been injected. The upper abdominal area is one of the
preferred areas for insulin injection.
DIF: Cognitive Level: Application
REF: 1226
TOP: Nursing Process:
Evaluation
MSC: NCLEX: Physiological Integrity
12. A patient receives aspart
(NovoLog
) insulin at 8:00 AM. Which time will it be most
important for the nurse to monitor for symptoms of hypoglycemia?
a. 9:00 AM
b. 11:30 AM
c. 4:00 PM
d. 8:00 PM
ANS: A
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for
hypoglycemia at the other listed times, although hypoglycemia may occur.
DIF: Cognitive Level: Comprehension REF: 1224 (Figure 49-3
)
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
13. Which patient action indicates a good understanding of the nurse’s teaching about the use
of an insulin pump?
a. The patient changes the site for the insertion site every week.
b. The patient programs the pump to deliver an insulin bolus after eating.
c. The patient takes the pump off at bedtime and starts it again each morning.
d. The patient states that diet will be less flexible when using the insulin pump.
ANS: B
In addition to the basal rate of insulin infusion, the patient will adjust the pump to
administer a bolus after each meal, with the dosage depending on the oral intake. The
insertion site should be changed every 2 or 3 days. There is more flexibility in diet and
exercise when an insulin pump is used. The pump will deliver a basal insulin rate 24
hours a day.
DIF: Cognitive Level: Application
REF: 1227-1228 TOP: Nursing Process:
Evaluation
MSC: NCLEX: Health Promotion and Maintenance
14. When teaching a diabetic patient who has just been started on intensive insulin therapy
about mealtime coverage, which type of insulin will the nurse need to discuss?
a. glargine (Lantus
)
b. lispro (Humalog
)
c. detemir (Levemir
)
d. NPH (Humulin N)
ANS: B
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-6
Rapid- or short-acting insulin is used for mealtime coverage for patients receiving
intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
DIF: Cognitive Level: Application
REF: 1224-1225 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
15. Which information will the nurse include when teaching a patient who has type 2
diabetes about glyburide
(Micronase, DiaBeta, Glynase
)?
a. Glyburide decreases glucagon secretion from the pancreas.
b. Glyburide stimulates insulin production and release from the pancreas.
c. Glyburide should be taken even if the morning blood glucose level is low.
d. Glyburide should not be used for 48 hours after receiving IV contrast media.
ANS: B
The sulfonylureas stimulate the production and release of insulin from the pancreas. If the
glucose level is low, the patient should contact the health care provider before taking the
glyburide, because hypoglycemia can occur with this category of medication. Metformin
should be held for 48 hours after administration of IV contrast media, but this is not
necessary for glyburide. Glucagon secretion is not affected by glyburide.
DIF: Cognitive Level: Application
REF: 1228-1230
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
16. Which patient statement after the nurse has completed teaching a patient with type 2
diabetes about taking glipizide (Glucotrol
) indicates a need for additional teaching?
a. “Other medications besides the Glucotrol may affect my blood sugar.”
b. “If I overeat at a meal, I will still take just the usual dose of medication.”
c. “When I become ill, I may have to take insulin to control my blood sugar.”
d. “My diabetes is not as likely to cause complications as if I needed to take insulin.”
ANS: D
The patient should understand that type 2 diabetes places the patient at risk for many
complications and that good glucose control is as important when taking oral agents as
when using insulin. The other statements are accurate and indicate good understanding of
the use of glipizide.
DIF: Cognitive Level: Application
REF: 1228-1230 | 1244-1245 | 1246-1252
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
17. A patient with type 2 diabetes that is well-controlled with metformin (Glucophage
)
develops an allergic rash to an antibiotic and the health care provider prescribes
prednisone (Deltasone
). The nurse will anticipate that the patient may
a. need a diet higher in calories while receiving prednisone.
b. require administration of insulin while taking prednisone.
c. develop acute hypoglycemia while taking the prednisone.
d. have rashes caused by metformin-prednisone interactions.
ANS: B
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-7
Glucose levels increase when patients are taking corticosteroids, and insulin may be
required to control blood glucose. Hypoglycemia is not a side effect of prednisone.
Rashes are not an adverse effect caused by taking metformin and prednisone
simultaneously. The patient may have an increased appetite when taking prednisone, but
will not need a diet that is higher in calories.
DIF: Cognitive Level: Application
REF: 1222 | 1231 | 1242
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
18. A hospitalized diabetic patient who received 34 U of NPH insulin at 7:00 AM is away
from the nursing unit, awaiting diagnostic testing when lunch trays are distributed. To
prevent hypoglycemia, the best action by the nurse is to
a. save the lunch tray to be provided upon the patient’s return to the unit.
b. call the diagnostic testing area and ask that a 5% dextrose IV be started.
c. ensure that the patient drinks a glass of milk or orange juice at noon in the
diagnostic testing area.
d. request that the patient be returned to the unit to eat lunch if testing will not be
completed promptly.
ANS: D
Consistency for mealtimes assists with regulation of blood glucoseRemember, the best option is
for the patient to have lunch at the usual time. Waiting to eat until after the procedure is
likely to cause hypoglycemia. Administration of an IV solution is unnecessarily invasive
for the patient. A glass of milk or juice will keep the patient from becoming
hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption
of the simple carbohydrate in these items.
DIF: Cognitive Level: Application
REF: 1244-1246
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
19. A patient with type 1 diabetes has been using self-monitoring of blood glucose (SMBG)
as part of diabetes management. During evaluation of the patient’s technique of SMBG,
the nurse identifies a need for additional teaching when the patient
a. washes the puncture site using soap and warm water.
b. chooses a puncture site in the center of the finger pad.
c. hangs the arm down for a minute before puncturing the site.
d. says the result of 130 mg indicates good blood sugar control.
ANS: B
The patient is taught to choose a puncture site at the side of the finger pad. The other
patient actions indicate that teaching has been effective.
DIF: Cognitive Level: Application
REF: 1234
TOP: Nursing Process:
Evaluation
MSC: NCLEX: Health Promotion and Maintenance
20. Which action should the nurse take first when teaching a patient who is newly diagnosed
with type 2 diabetes about home management of the disease?
a. Ask the patient’s family to participate in the diabetes education program.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-8
b. Assess the patient’s perception of what it means to have diabetes mellitus.
c. Demonstrate how to check glucose using capillary blood glucose monitoring.
d. Discuss the need for the patient to actively participate in diabetes management.
ANS: B
Before planning education, the nurse should assess the patient’s interest in and ability to
self-manage the diabetes. After assessing the patient, the other nursing actions may be
appropriate, but planning needs to be individualized to each patient.
DIF: Cognitive Level: Application
REF: 1239
TOP: Nursing Process:
Planning
MSC: NCLEX: Health Promotion and Maintenance
21. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC
) is made for a
patient with type 2 diabetes who is brought to the emergency department in an
unresponsive state. The nurse will anticipate the need to
a. give 50% dextrose as a bolus.
b. insert a large-bore IV catheter.
c. initiate oxygen by nasal cannula.
d. administer glargine (Lantus
) insulin.
ANS: B
HHNC is initially treated with large volumes of IV fluids to correct hypovolemia.
Regular insulin is administered, not a long-acting insulin. There is no indication that the
patient requires oxygen. Dextrose solutions will increase the patient’s blood glucose and
would be contraindicated.
DIF: Cognitive Level: Application
REF: 1244-1245 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
22. A patient with type 1 diabetes who uses glargine (Lantus
) and lispro (Humalog
) insulin
develops a sore throat, cough, and fever. When the patient calls the clinic to report the
symptoms and a blood glucose level of 210 mg/dL, the nurse advises the patient to
a. use only the lispro insulin until the symptoms of infection are resolved.
b. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
c. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
d. limit intake of calorie-containing liquids until the glucose is less than 120 mg/dL.
ANS: B
Infection and other stressors increase blood glucose levels and the patient will need to test
blood glucose frequently, treat elevations appropriately with lispro insulin, and call the
health care provider if glucose levels continue to be elevated. Discontinuing the glargine
will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA).
Decreasing carbohydrate or caloric intake is not appropriate because the patient will need
more calories when ill. Glycosylated hemoglobins are not used to test for short-term
alterations in blood glucose.
DIF: Cognitive Level: Application
REF: 1236-1239
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-9
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
23. The health care provider suspects the Somogyi effect in a patient whose 7:00 AM blood
glucose is 220 mg/dL. Which action will the nurse plan to take?
a. Check the patient’s blood glucose at 3:00 AM.
b. Administer a larger dose of long-acting insulin.
c. Educate about the need to increase the rapid-acting insulin dose.
d. Remind the patient about the need to avoid snacking at bedtime.
ANS: A
If the Somogyi effect is causing the patient’s increased morning glucose level, the patient
will experience hypoglycemia between 2 and 4 AM. The dose of insulin will be reduced,
rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during
the night.
DIF: Cognitive Level: Application
REF: 1228-1230 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
24. Intramuscular glucagon is administered to an unresponsive patient for treatment of
hypoglycemia. Which action should the nurse take after the patient regains
consciousness?
a. Assess the patient for symptoms of hyperglycemia.
b. Give the patient a snack of crackers and peanut butter.
c. Have the patient drink a glass of orange juice or nonfat milk.
d. Administer a continuous infusion of 5% dextrose for 24 hours.
ANS: B
Rebound hypoglycemia can occur after glucagon administration, but having a meal
containing complex carbohydrates plus protein and fat will help prevent hypoglycemia.
Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and
crackers will stabilize blood sugar. Administration of glucose intravenously might be
used in patients who were unable to take in nutrition orally. The patient should be
assessed for symptoms of hypoglycemia after glucagon administration.
DIF: Cognitive Level: Application
REF: 1246
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
25. Which question by the nurse will help identify autonomic neuropathy in a diabetic
patient?
a. “Have you observed any recent skin changes?”
b. “Do you notice any bloating feeling after eating?”
c. “Do you need to increase your insulin dosage when you are stressed?”
d. “Have you noticed any painful new ulcerations or sores on your feet?”
ANS: B
Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated
feeling for the patient. The other questions also are appropriate to ask, but would not help
in identifying autonomic neuropathy.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-10
DIF: Cognitive Level: Application
REF: 1250
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
26. A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral
arterial disease. Which information will the nurse include in patient teaching?
a. Choose flat-soled leather shoes.
b. Set heating pads on a low temperature.
c. Buy callus remover for corns or calluses.
d. Soak the feet in warm water for an hour every day.
ANS: A
The patient is taught to avoid high heels and that leather shoes are preferred. The feet
should be washed, but not soaked, in warm water daily. Heating pad use should be
avoided. Commercial callus and corn removers should be avoided. The patient should see
a specialist to treat these problems.
DIF: Cognitive Level: Application
REF: 1251
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
27. The nurse obtains the following information about a patient before administration of
metformin (Glucophage
). Which finding indicates a need to contact the health care
provider before giving the metformin?
a. The patient’s blood glucose level is 166 mg/dL.
b. The patient’s blood urea nitrogen
(BUN) level is 60 mg/dL.
c. The patient is scheduled for a chest x-ray in an hour.
d. The patient has gained 2 lb (0.9 kg
) since yesterday.
ANS: B
The BUN indicates impending renal failure and metformin should not be used in patients
with renal failure. The other findings are not contraindications to the use of metformin.
DIF: Cognitive Level: Application
REF: 1228-1230
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
28. Amitriptyline
(Elavil
) is prescribed for a diabetic patient who has burning foot pain at
night. Which information should the nurse include when teaching the patient about the
new medication?
a. Amitriptyline will decrease the depression caused by your foot pain.
b. Amitriptyline will correct some of the blood vessel changes that cause pain.
c. Amitriptyline will improve sleep and make you less aware of nighttime pain.
d. Amitriptyline will help prevent the transmission of pain impulses to the brain.
ANS: D
Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord
and brain. Tricyclics also improve sleep quality and are used for depression, but that is
not the major purpose for their use in diabetic neuropathy. The blood vessel changes that
contribute to neuropathy are not affected by tricyclics.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-11
DIF: Cognitive Level: Application
REF: 1249-1250
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
29. A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which
information obtained by the nurse is most important to report to the health care provider
before the procedure?
a. The patient’s admission blood glucose is 128 mg/dL.
b. The patient’s most recent Hb A1C was 6.5%.
c. The patient took the prescribed metformin (Glucophage
) today.
d. The patient took the prescribed captopril (Capoten
) this morning.
ANS: C
To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary
arteriogram and should not be used for 48 hours after IV contrast media are administered.
The other patient data also will be reported but do not indicate any need to reschedule the
procedure.
DIF: Cognitive Level: Application
REF: 1236-1239
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
30. After the home health nurse has taught a patient and family about how to use glargine and
regular insulin safely, which action by the patient indicates that the teaching has been
successful?
a. The patient administers the glargine 30 to 45 minutes before eating each meal.
b. The patient’s family fills the syringes weekly and stores them in the refrigerator.
c. The patient draws up the regular insulin and then the glargine in the same syringe.
d. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
ANS: D
Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with
other insulins or prefilled and stored. Short-acting regular insulin is administered before
meals, while glargine is given once daily.
DIF: Cognitive Level: Application
REF: 1224-1226 TOP: Nursing Process:
Evaluation
MSC: NCLEX: Physiological Integrity
31. The nurse teaches the diabetic patient who rides a bicycle to work every day to
administer morning insulin into the
a. arm.
b. thigh.
c. buttock.
d. abdomen.
ANS: D
Patients should be taught not to administer insulin into a site that will be exercised
because exercise will increase the rate of absorption. The thigh, buttock, and arm are all
exercised by riding a bicycle.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-12
DIF: Cognitive Level: Application
REF: 1226-1227
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
32. Which information about a patient who receives rosiglitazone (Avandia
) is most
important for the nurse to report immediately to the health care provider?
a. The patient’s blood pressure is 154/92.
b. The patient has a history of emphysema.
c. The patient’s noon blood glucose is 86 mg/dL.
d. The patient has chest pressure when ambulating.
ANS: D
Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the
health care provider and expect orders to discontinue the medication. There is no urgent
need to discuss the other data with the health care provider.
DIF: Cognitive Level: Application
REF: 1230
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
33. A pregnant patient who has no personal history of diabetes, but does have a parent who is
diabetic is scheduled for the first prenatal visit. Which action will the nurse plan to take
on this initial visit?
a. Teach about appropriate use of regular insulin.
b. Discuss the need for a fasting blood glucose level.
c. Schedule an oral glucose tolerance test for the twenty fourth week of pregnancy.
d. Provide education about increased risk for fetal problems with gestational diabetes.
ANS: B
Patients at high risk for gestational diabetes should be screened for diabetes on the initial
prenatal visit. An oral glucose tolerance test also may be used to check for diabetes, but it
would be done before the twenty fourth week. The other actions also may be needed
(depending on whether the patient develops gestational diabetes
), but they are not the first
actions that the nurse should take.
DIF: Cognitive Level: Application
REF: 1221-1223
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
34. A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level
of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take
first?
a. Infuse regular insulin at 20 U/hr.
b. Place the patient on a cardiac monitor.
c. Administer IV potassium supplements.
d. Obtain urine glucose and ketone levels.
ANS: B
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-13
Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia
and ventricular fibrillation, which would be detected with ECG monitoring. Since
potassium must be infused over at least 1 hour, the nurse should initiate cardiac
monitoring before infusion of potassium. Insulin should not be administered without
cardiac monitoring, since insulin infusion will further decrease potassium levels. Urine
glucose and ketone levels are not urgently needed to manage the patient’s care.
DIF: Cognitive Level: Application
REF: 1244
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
35. A diabetic patient is admitted with ketoacidosis and the health care provider writes these
orders. Which order should the nurse implement first?
a. Administer regular IV insulin 30 U.
b. Infuse 1 liter of normal saline per hour.
c. Give sodium bicarbonate 50 mEq IV push.
d. Start an infusion of regular insulin at 50 U/hr.
ANS: B
The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis
(DKA), and the priority is to infuse IV fluids. The other actions can be accomplished
after the infusion of normal saline is initiated.
DIF: Cognitive Level: Application
REF: 1244
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
36. When the nurse is assessing a patient who is recovering from an episode of diabetic
ketoacidosis, the patient reports feeling anxious, nervous, and sweaty. Which action
should the nurse take first?
a. Administer 1 mg glucagon subcutaneously.
b. Obtain a glucose reading using a finger stick.
c. Have the patient drink 4 ounces of orange juice.
d. Give the scheduled dose of lispro (Humalog
) insulin.
ANS: B
The patient’s clinical manifestations are consistent with hypoglycemia and the initial
action should be to check the patient’s glucose with a finger stick or order a stat blood
glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such
as orange juice. Glucagon might be given if the patient’s symptoms become worse or if
the patient is unconscious. Administration of lispro would drop the patient’s glucose
further.
DIF: Cognitive Level: Application
REF: 1245-1246
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-14
37. Which information from the patient’s health history is most important for the nurse to
communicate to the health care provider when a patient has an order for an oral glucose
tolerance test?
a. The patient uses oral contraceptives.
b. The patient runs several days a week.
c. The patient has a family history of diabetes.
d. The patient had a viral illness 2 months ago.
ANS: A
Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT
) values. A
viral illness 2 months previously may be associated with the onset of type 1 diabetes but
will not falsely affect the OGTT. Exercise and a family history of diabetes both can affect
blood glucose but will not lead to misleading information from the OGTT.
DIF: Cognitive Level: Application
REF: 1222
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
38. Which of these laboratory values, noted by the nurse when reviewing the chart of a
hospitalized diabetic patient, indicates the need for rapid assessment of the patient?
a. Hb A1C of 5.8%
b. Noon blood glucose of 52 mg/dL
c. Hb A1Cof 6.9%
d. Fasting blood glucose of 130 mg/dL
ANS: B
The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms
of hypoglycemia, and give the patient some carbohydrate-containing beverage such as
orange juice. The other values are within an acceptable range for a diabetic patient.
DIF: Cognitive Level: Application
REF: 1245
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
39. The nurse and LPN/LVN are caring for a type 2 diabetic patient who is admitted for
gallbladder surgery. Which nursing action can the nurse delegate to the LPN/LVN?
a. Communicate the blood glucose and insulin dose to the circulating nurse in
surgery.
b. Discuss the reason for the use of insulin therapy during the immediate
postoperative period.
c. Administer the prescribed lispro (Humalog
) insulin before transferring the patient
to surgery.
d. Plan strategies to minimize the risk for hypo- or hyperglycemia during the
postoperative hospitalization.
ANS: C
LPN/LVN education and scope of practice includes administration of insulin.
Communication about patient status with other departments, planning, and patient
teaching are skills that require RN education and scope of practice.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Test Bank
49-15
DIF: Cognitive Level: Application
REF: 1252
OBJ: Special Questions: Delegation
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.