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CHAPTER 48: DIABETES MELLITUS LEWIS: MEDICAL-SURGICAL NURSING,10TH EDITION
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CHAPTER 48: DIABETES MELLITUS LEWIS: MEDICAL-SURGICAL NURSING,10TH EDITION
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CHAPTER 48: DIABETES MELLITUS LEWIS:MEDICAL-SURGICAL NURSING,10TH EDITION
1. Which statement by a nurse to a patient newly diagnosed with 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. Changes in diet and exercise may control blood glucose levels in type 2
diabetes.
d. Type 2 diabetes is usually diagnosed when the patient is admitted with a
hyperglycemic coma. - CORRECT ANSWER-ANS: C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to
achieve 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: Understand (comprehension) REF: 1134
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. The nurse is assessing a 22-yr-old patient experiencing the onset of
symptoms of type 1 diabetes. To which question would the nurse anticipate a
positive response?
a. "Are you anorexic?"
b. "Is your urine dark colored?"
c. "Have you lost weight lately?"
,d. "Do you crave sugary drinks?" - CORRECT ANSWER-ANS: C
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: Apply (application)
TOP: Nursing Process: Assessment
REF: 1121
MSC: NCLEX: Physiological Integrity
5. A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic
several months from now. Which test will the nurse schedule to evaluate the
effectiveness of treatment for the patient?
a. Fasting blood glucose
b. Oral glucose tolerance
c Glycosylated hemoglobin
d. Urine dipstick for glucose - CORRECT ANSWER-_ANS: C
The glycosylated hemoglobin (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 after diabetes has been diagnosed.
,DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Planning
REF: 1124
MSC: NCLEX: Physiological Integrity
6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes who
has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most
important for this patient?
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
b. The patient will follow 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. -
CORRECT ANSWER-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. A BMI of 30?9?kg/m2 or above is considered obese, so the other
outcomes are appropriate but are not as high in priority.
DIF: Cognitive Level: Analyze (analysis) REF: 1124
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. A patient who has type 1 diabetes plans to swim laps for an hour 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. -
CORRECT ANSWER-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: Apply (application)
TOP: Nursing Process: Planning
REF: 1132
MSC: NCLEX: Physiological Integrity
8. The nurse determines a need for additional instruction when the patient
with newly diagnosed type 1 diabetes says which of the following?
a. "I will need a bedtime snack because I take an evening dose of NPH insulin."
b. "I can choose any foods, as long as I use enough insulin to cover the
calories."
c. "I can have an occasional beverage with alcohol if I include it in my meal
plan."
d. "I will eat something at meal times to prevent hypoglycemia, even if I am not
hungry." - CORRECT ANSWER-ANS: B
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