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College of Nursing
SY 2011-2012
FIRST SEMESTER
DM ACITIVITY
1.
MULTIPLE CHOICE
1. The nurse explains that type 1 diabetes mellitus is a disease in which the body does not
produce enough insulin so my blood glucose is elevated because of
1. prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon, growth hormone).
2. malfunction of the glycogen-storing capabilities of the liver.
3. destruction of the beta cells in the pancreas.
4. insulin resistance of the receptor cells of the muscle tissue.
RATIONALE:________________________________________________________________________________
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2. When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a
pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but:
1. overweight and underactive people simply cannot use the insulin produced.
2. metabolism is slowed in some people so they have to take a pill to speed up their metabolism.
3. sometimes the autoimmune system works against the action of the insulin.
4. the cells become resistant to the action of insulin. Pills are given to increase the sensitivity.
RATIONALE:________________________________________________________________________________
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3. A patient tells the nurse that she eats huge amounts of food but stays hungry most of the
time. The nurse explains that hunger experienced by persons with type 1 diabetes is caused by
the:
1. excess amount of glucose
2. need for additional calories to correct the increased metabolism.
3. fact that the cells cannot use the blood glucose.
4. need for exercise to stimulate insulin secretion.
RATIONALE:________________________________________________________________________________
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4. The nurse stresses that the type 1 diabetic is at risk for cardiovascular disorders because lack
of insulin causes:
1. high glucose levels that irritate and shrink the vessels.
2. inadequate metabolism of proteins, which causes ketosis.
3. increased fatty acid levels.
9. The nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a
life-threatening condition that results in:
1. the inability of carbohydrates, fats, and proteins to be metabolized.
2. the storage of glycogen, so that there is a severe shortage of glucose in the bloodstream.
3. dangerously elevated pH and bicarbonate levels in the blood.
4. severe hypoglycemia, which can result in coma and convulsions.
RATIONALE:________________________________________________________________________________
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10. The patient has been admitted to the hospital with the diagnosis of diabetic ketoacidosis. The
nurse anticipates that the patient will exhibit vital signs of:
1. T, 99; P, 62; R, 16 and shallow.
2. T, 98.6; P, 76; R, 16 and deep.
3. T, 98; P, 84; R, 18 and shallow.
4. T, 97.4; P, 100; R, 20 and deep.
RATIONALE:________________________________________________________________________________
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11. The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6
months. The nurse is surprised and concerned about a blood glucose reading of 52. This episode
of hypoglycemia is probably caused by the patients having:
1. taken a new form of birth control pill this morning.
2. used large amounts of sugar substitute in her tea this morning.
3. had a 2-hour long exercise class at the spa this morning.
4. underdosed herself with insulin this morning.
RATIONALE:________________________________________________________________________________
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12. As part of the teaching plan in preparation for discharge, the patient with type 1 diabetes
needs guidelines for exercise. Be sure to include which of the following?
1. Plan your exercise so that it coincides with the peak action of insulin.
2. Insulin should be injected into the lower extremity before exercise because that site provides the greatest
absorption.
3. Exercise should be done daily at the same time of day and at the same intensity.
4. Keep exercise at a minimum to conserve your energy.
RATIONALE:________________________________________________________________________________
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13. The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has
ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The proper
procedure is to:
1. draw up the insulins in two separate syringes so that there can be no confusion.
20. In drawing up a patient diabetes teaching plan, the nurse needs to include the following:
1. Develop an exercise plan, because regular exercise helps control your blood glucose level.
2. Monitor your blood sugar only if you are not feeling well so that you dont prick your fingertips too much.
3. If you are experiencing nervousness, palpitations, or hunger, take a small dose (1 to 2 U) of regular insulin
and call the doctor.
4. Use over-the-counter measures for any foot blisters, calluses, or wounds before you seek medical help.
RATIONALE:________________________________________________________________________________
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21. A patient who has been diagnosed with endogenous hypoglycemia most likely has:
1. taken an overdose of hypoglycemic drugs.
2. been following a very restricted fasting diet or is malnourished.
3. excessive secretion of insulin or an increase in glucose metabolism.
4. exercised unwittingly without replenishing needed fluid and nutrients.
RATIONALE:________________________________________________________________________________
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22. The nurse giving Humulin R 20 U at 7 AM is aware that this drug will peak in:
1. 15 minutes.
2. 30 minutes.
3. 1 hour.
4. 2 hours.
RATIONALE:________________________________________________________________________________
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23. It is recognized that people with diabetes are at greater risk for complications than
nondiabetic patients because of:
1. high blood pressure, which can lead to a stroke.
2. genetic susceptibility, which leads to a generalized weakening of the immune system.
3. thickening of the basement membrane of the capillaries.
4. chronic pain, which leads to activity intolerance.
RATIONALE:________________________________________________________________________________
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24. The nurse suspects that the patient with type 1 diabetes may be experiencing the Somogyi
phenomenon when the patient exhibits:
1. headache on awakening and enuresis.
2. 6 AM blood sugar of 58 and nausea.
3. abdominal pain and blood pressure elevation.
4. drowsiness and disorientation after eating.
RATIONALE:________________________________________________________________________________
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25. The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome
(HHNKS). Her blood glucose level is very high (880 mg/dL on admission). The physician believes
that her condition is to the result of large amounts of glucose solutions administered
intravenously during kidney dialysis. The nurse would anticipate that the patient would exhibit:
1. a fruity breath and high level of ketones in her urine.
2. severe dehydration and hypernatremia caused by the hyperglycemia.
3. exactly the same symptoms and signs as diabetic ketoacidosis.
4. Kussmauls respirations, nausea, and vomiting.
RATIONALE:________________________________________________________________________________
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26. The nurse tells a patient that the functional causes of hypoglycemia include (select all that
apply):
1. dumping syndrome.
2. overdose of insulin.
3. Addisons disease.
4. spontaneous hypoglycemia.
5. chronic alcoholism.
RATIONALE:________________________________________________________________________________
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27. The teaching plan for a diabetic patient for foot care would include that the patient should
(select all that apply):
1. wash and carefully dry the feet every day.
2. apply lotion between the toes.
3. protect the feet from extreme temperatures.
4. walk barefoot only indoors.
5. buy shoes that are comfortable and supportive.
RATIONALE:________________________________________________________________________________
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28. The teaching plan for a diabetic is focused on smoking cessation and control of hypertension
for the avoidance of microvascular complications, such as (select all that apply):
1. macular degeneration.
2. end-stage renal disease (ESRD).
3. coronary artery disease (CAD).
4. peripheral vascular disease (PVD).
5. cerebrovascular accident (CVA).
RATIONALE:________________________________________________________________________________
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29. The nurse instructs a patient about how insulin affects blood glucose. Arrange the events in
sequence.
1. Beta cells are stimulated to release insulin.
2. Glucose enters the bloodstream.
3. Glycogen is converted to glucose by alpha cells (glycogenesis).
4. Glycogen is stored in the liver.
5. Insulin transports glucose to muscle cells.
RATIONALE:________________________________________________________________________________
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