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1. A client is managing his diabetes with exercise and diet. The health care provider reviews the client's most recent lab results: fasting blood sugar level at 80 mg/dL and a hemoglobin A1C of 5%. Select the response that best identifies the client.: The client is achieving normal glycemic control.
2. A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume?: The patient is achieving normal glycemic control.
3. When educating a patient about glargine (Lantus), the nurse should explain that this medication:: Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.
4. The nurse has just completed teaching a client newly diagnosed with type 1 diabetes about rapid-acting insulin. The nurse determines that teaching was effective when the client selects:: Lispro

5. The nurse is reviewing assessment data on four clients. Select the client at highest risk for developing type 2 diabetes.: A 45- year-old obese female with a sedentary lifestyle
6. The obstetrical nurse is caring for a client who has been treated for ges- tational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teach- ing?: Woman with a family history of diabetes
7. The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause?: Blood glucose will elevate.
8. A patient with diabetes asks the nurse for advice in controlling be- tween-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level?: Glargine (Lantus) 9.Which of the following clients would be considered to be

exhibiting manifes- tations of "prediabetes"?: A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow- up OGTT of 189 mg/dL. 10.Type 2 diabetes is caused by metabolic abnormalities in the presence of insulin. What are these metabolic abnormalities? (Select all that apply.): • Deranged secretion of insulin

• Insulin resistance
• Increased glucose production by the liver

11. The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be:: The brain relies on blood glucose as its main energy source. 12.What are the hallmark signs of diabetes mellitus?: Polyuria, polydipsia, and polyphagia 13.A client with type 1 diabetes mellitus wishes to stop taking insulin injec- tions. What option is appropriate?: Using an insulin infusion pump

14.Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes.: Inspect the feet for blisters daily 15.The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL. The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?: Administration of intravenous fluids 16.A client diagnosed with type 2 diabetes has been instructed about manag- ing his condition with diet. The nurse determines further teaching is necessary when the client states:: "I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." 17.Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes?: Complete failure of insulin secretion 18.During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for

extended periods of time, what can occur?: Hyperglycemia 19.Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?: Genetic predisposi- tion, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen 20.A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?: Random blood glucose 85 mg/dl 21.The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is:: "Insulin is destroyed by the stomach contents and has to be administered by injection." 22.A pregnant client asks the nurse if she is at risk for developing gestational diabetes. The nurse reviews the risk factors with the client. The most important information for the nurse to provide would be: Select all that apply.: • Polycystic ovary disease

• Glycosuria
• Severe obesity 23.A young child develops type 1A diabetes. The parents ask, "They tell us this is genetic. Does that mean our other children will get diabetes?" The best response by the health care provider would be:: "This autoimmune disorder causes destruction of the beta cells, placing your children at high risk of developing diabetes." 24.A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes .The best diagnostic indicator that would support the client's response would be:: Glycosylated hemoglobin, hemoglobin A1C (HbA1C) 25.The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority?: Give the client a concentrated carbohydrate. 26.The diagnosis of type 1 diabetes would be confirmed by:: Insulin is not available for use by the body. 27.The pancreas is an endocrine organ that is composed of the

acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin?: Beta cells 28.Which of the following interventions is important for the nurse to teach a patient diagnosed with distal symmetric neuropathy related to diabetes? Select all that apply.: • Inspect the feet daily for blisters.

• Wear well-fitted shoes.

29. The nurse educates a patient newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that one gram of fat will provide kcal of energy.: 9 30.Select the most common symptoms of diabetes. Select all that apply.: • Polydipsia

• Polyuria
• Polyphagia 31.Following an oral glucose tolerance, a 36 year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous

pregnancies. What should her primary care provider tell her about this new health problem?: "Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars." 32.Diabetics are hospitalized for a number of reasons. What is the most common complication of diabetes requiring hospitalization?: Foot problems

33. A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and

when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?: Hypoglycemia 34.The family of a client in the hospital with diabetes mellitus out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond?: Glucose is unused without insulin, so body fats are used for energy. 35.A patient has been admitted with diabetic ketoacidosis. The Emergency Department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which of the following clinical manifestations?: Headaches, dizziness, change in level of consciousness. 36.A nurse is evaluating patients for the risk of developing type 2 diabetes. Which of the following patients has the highest risk?: A 45-year-old obese woman with a sedentary lifestyle 37.A patient with distal symmetric polyneuropathy usually

begins by com- plaining of:: Loss of feeling or touch in the feet. 38.A pancreatitis patient is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parental nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the patient for which clinical manifestations (listed below)?: Dry lips, excess urine output, and seizures. 39.A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response pro- vides the most effective information?: Maintain healthy blood pressure and blood sugar levels. 40.A client with severe hypoglycemia is unconscious. Which method of pro- viding glucose should be avoided?: Orange juice orally 41.A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the

options.: • Decrease in pH

• Breakdown of triglycerides
• Low serum insulin levels
• Ketone production by the liver
• Production of fatty acids and glycerol 42.A client with diabetes mellitus reports morning hyperglycemia for several days. What action should taken?: Check blood glucose at 2 AM 43.A client with type 2 diabetes has routine lab work, which reveals elevated free fatty acids (FFA). The client asks, "Why is this significant?" The most accurate response would be: Select all that apply.: • This may increase the amount of triglyceride (a form of fat) stored in your liver or around your heart.
• Your pancreas is affected by increased fat (lipotoxicity), which causes beta cell dysfunction, leading to the need for insulin. 44.When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source?:

Brain 45.A client with diabetes mellitus has sudden onset of slurred speech, inco- ordination, and cool, clammy skin. What will the nurse do first?: Check blood glucose 46.A 46 year-old man who is obese has received news that he has type 2 diabetes. He is in the process of determining a plan of care with an inter- disciplinary team at a hospital-based diabetes clinic. The nurse knows that the most likely treatment plan for the man will include:: Oral antihyperglycemic medications and weight loss measures. 47.A newly diagnosed type 2 diabetic client has been prescribed metformin. When explaining the actions of this medication, the nurse should include which statement? This medication:: Inhibits hepatic glucose production and in- creases the sensitivity of peripheral tissues to the actions of insulin 48.The nurse and nursing student are performing medication reconciliation. Which of these medications taken by the client does the nurse teach the student are implicated in causing hyperglycemia? Select all that apply.: • Loop diuretics

• Glucocorticoids
• Oral contraceptives 49.A 30 year-old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin? Select all that apply.: • Facili- tating triglyceride synthesis from glucose in fat cells
• Inhibiting protein breakdown
• Promoting glucose uptake by target cells. 50.Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?: Somogyi effect 51.A patient is diagnosed with hyperglycemic hyperosmolar state (HHS). Which of the following factors contribute to the severe hyperglycemia that precipitates HHS? Select all that apply: • Hyperglucagonemia
• Glycosuria and dehydration
• Hepatic glycogenolysis
• Insulin deficiency

52.The nurse is teaching a client with diabetes about medications that will increase the blood glucose level. The most important information for the nurse to provide would be: Select all that apply.: • Loop diuretics

• Oral contraceptives
• Total parenteral nutrition
• Antipsychotics 53.A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply.: • Glyburide
• Insulin 54.For which conditions is diabetes mellitus a risk factor? Select all that apply.: • Coronary artery disease
• Cerebrovascular accident
• Chronic kidney disease 55.A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2

diabetes mellitus? Select all that apply.: • Onset before age 20

• Autoimmune beta cell damage
• Abrupt onset of symptoms 56.A 54 year-old male who lives alone and has poorly controlled type 1 diabetes has been admitted to hospital for treatment of sepsis resulting from a chronic foot ulcer. Which of the other findings from the man's admission assessment and history would his care team be likely to attribute to his diabetes? Select all that apply.: • The client complains of bloating after eating a meal, and states that he is unable to eat much food at any one sitting.
• He states that his bowel movements are almost always loose.
• The client states that he has been unable to maintain an erection in recent years. 57.A patient is diagnosed with metabolic syndrome. Frequent concomitants of this syndrome include which of the following? Select all that apply.: • Body mass index (BMI) greater than 30
• Elevated fasting blood glucose (FBG)
• Coronary artery disease
• Hypertriglyceridemia

58.A client with diabetes mellitus arrives at the hospital with a blood glucose level of 639 mg/dl. What assessment data would indicate type 2 diabetes mellitus rather than type 1?: Negative ketones in urine 59.Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia?: Altered cerebral function and headache 60.A 15 year-old boy with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which of the following responses by his mother is most accurate?: "Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road." 61.While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which of the following accurate information?: In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.

62.Which complications may be experienced by a client with diabetic neu- ropathies? Select all that apply.: • Foot ulcers

• Gastroparesis
• Erectile dysfunction
• Urinary retention 63.Secondary diabetes occurs because of disorders that produce hyper- glycemia by stimulating the hepatic production of glucose or decrease the cellular use of glucose. Which disorders can be causes of secondary dia- betes?: Pheochromocytoma and Cushing syndrome 64.A patient hospitalized with type 1 diabetes has been administered a sched- uled dose of regular insulin. Which of the following are processes of insulin? Select all that apply.: • Fat storage
• Glucose uptake by muscle and adipose tissue
• Protein synthesis 65.A three year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain

to the parents the etiology (cause) of their daughter's diabetes?: "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." 66.Which of the following statements best describes an aspect of the normal process of glucose metabolism?: Glucose that exceeds metabolic needs is con- verted and stored by the liver. 67.A client is admitted to the emergency department and diagnosed with diabetic ketoacidosis (DKA). The client would most likely manifest:: Ketosis 68.Hormones that counteract insulin's storage function when regulating blood glucose during times when glucose intake is limited or glucose stores are depleted are called counterregulatory hormones. What are the counterreg- ulatory hormones? (Select all that apply.): • Glucocorticoids

• Growth hormone
• Catecholamines
• Glucagon 69.The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a

primary healthcare provider for further evaluation?: Random blood glucose 195 mg/dl 70.A client is brought to the emergency department with a suspected diagno- sis of DKA (diabetic ketoacidosis). Select the assessment/diagnostic data to confirm the diagnosis. Select all that apply.: • Low serum bicarbonate

• Positive urine ketones

71. A young adult has been experiencing some extreme fatigue, changes in vision and unexpected weight loss. At the health clinic, the healthcare provider is assessing for hyperglycemia. Which would be considered the most commonly identifiable signs/symptoms of diabetes? Select all that apply.: • Frequent thirst

• Excess urination
• Ravaging hunger 72.A 30-year-old male who manages his type 1 diabetes with glyburide pre- sents at the emergency room complaining of headache, confusion, and tachy- cardia. He has come from a party at which he drank two beers to celebrate running his first

half-marathon. Which of the following is likely to be the cause of his complaints?: Hypoglycemia 73.Which manifestation indicates a client is at risk for developing diabetes mellitus?: 2 hour oral GTT 175 mg/dl 74.A client admitted to the hospital with elevated blood glucose is diagnosed with type 2 diabetes mellitus. What characteristics commonly differentiate type 2 diabetes mellitus from type 1 diabetes mellitus? Select all that apply.: • Onset after age 35

• Overweight 75.Which clients with diabetes mellitus would the nurse anticipate to have persistent elevation of blood glucose levels? Select all that apply.: • A client with high anxiety
• A client with COPD taking steroids
• A client with a leg fracture 76.Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply.: • Hemoglobin A1c 9.1%
• 2 hour oral GTT 245 mg/dl 77.A diabetic client presents to the clinic. He is concerned his

lower legs are "feeling funny." Which of the following assessment findings lead the health care provider to suspect the client may have developed somatic neuropathy? Select all that apply.: • Both legs appear to be the same as far as numbness is involved.

• Bilateral cool ankles and feet.
• With eyes closed, the client cannot identify where the HCP is touching his feet. 78.A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing:: Dawn phenomenon 79.The nurse knows that increased blood glucose levels will pull water out of cells and result in which of the following? Select all that apply.: • Polydipsia
• Polyuria 80.A patient is evaluated for diabetes. Which of the following

signs and symptoms would the nurse identify as indications of increased blood glucose levels? Select all that apply.: • Blurred vision

• Thirst
• Fatigue
• Skin infections 81.While working on the med-surg floor, the nurse has a client who is experi- encing an insulin reaction. The client is conscious and can follow directions. The most appropriate intervention would be:: Immediately administer 15 g of glucose (preferably via oral route if the client is alert enough to swallow) and wait for 15 minutes. Then repeat this if necessary. 82.A 15-year-old who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Americans. She asks you if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which of the following would be the most appropriate response?: Explain that almost all people with type 1 diabetes do

experience some degree of vision loss. 83.A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a success- ful outcome?: Glycosylated hemoglobin 5.2%

84. A 40 year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which of the following aspects of the man's obesity likely contributed to his new health problem?- : Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance. 85.A client presents to the emergency room with fatigue, weakness, dehydra- tion and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? Select all that apply.: • Recent weight loss

• Polyuria
• Blurred vision

86. A 48-year-old male client diagnosed with type 2 diabetes presents with the following:

- Blood glucose level of 46 mg/dL - Very lethargic - Has cool, clammy skin.: Administer injectable glucagon 87.A diabetic patient's most recent blood work indicated a decreased glomerular filtration rate, and urine testing revealed microalbuminuria. Which of the following self-care measures should the nurse suggest to the patient? Select all that apply.:

• Stop smoking.
• Maintain systolic pressure below 130 mm Hg.
• Restrict protein consumption. 88.The nurse screening for diabetes mellitus at a health fair does not have enough supplies for all of the clients attending. Which clients should be given screening priority?: • Male age 45, BMI 32
• Female age 30, history GDM
• Male age 65, hypertension 89.A patient with diabetes has been injured. The nurse will tell the patient that healing of the injury may be delayed due to which of the following diabetic complications? Select all that

apply.: • Chronic neuropathies

• Vascular impairment 90.The nurse is caring for a client diagnosed with diabetes mellitus who is reporting burning pain of his feet. The nurse would interpret this as:: Somatic neuropathy 91.While reviewing the role of glucagon in regards to regulation of blood glucose, the nurse knows which of the following situations could lead to an inhibition of glucagon release?: An increase in glucose levels.