GROUP-4
Evaluation exam DM and DI with rationale
1. Nurse Dimaano teaches a client with diabetes mellitus about differentiating
between hypoglycemia and ketoacidosis. The client demonstrates an
understanding of the teaching by stating that a form of glucose should be taken
on which symptoms develop?
A. Shakiness, light-headedness, blurred vision
B. Light-headedness, palpitations, shakiness
C. polyuria, fruity breath odor, blurred vision
D. shakiness , palpitations, fruity breath odor
Correct answer: B.
Rationale: Light-headedness, palpitations, and shakiness are signs/symptoms of
hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred
vision, and a fruity breath odor are manifestations of hyperglycemia.
2. Clinical nursing assessment for a patient with microangiopathy who has
manifested impaired peripheral arterial circulation includes all of the
following, except:
A. Integumentary inspection for the presence of brown spots on the lower extremities
B. Observation for paleness of the lower extremities
C. Observation for blanching of the feet after the legs is elevated for 60 seconds
D. Palpation for increased pulse volume in the arteries of the lower extremities
Correct answer: D
Rationale: one of the signs and symptoms of impaired peripheral arterial circulation is
the absence of a pulse or a weak pulse in the legs or feet.
3. Mr.Kanor, a 40 year old company driver presents with anxiety, sweating,
palpitations and shakiness, tells the nurse he has type 1 diabetes mellitus. Which
of the following actions should the nurse do first?
A. Inject 1 mg of glucagon subcutaneously
B. Administer 50 mL of 50% glucose I.V
C. Give 4 to 6 oz (118 to 177 mL) of orange juice
D. Give the client four to six glucose tablets
Correct answer:C
Rationale: Because the client is awake and complaining of symptoms, the nurse
should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4
to 6 oz of fruit juice, five to six hard candies, or 1 tablespoon of sugar.
4. Nurse Allie is preparing a plan of care for a client with diabetes mellitus who
has hyperglycemia. The nurse places priority on which on the client problem?
A. Lack of knowledge
B. Inadequate fluid volume
C. Compromised family coping
D. Inadequate consumption of nutrients
Correct answer:B
Rationale: An increased blood glucose level will cause the kidneys to excrete the
glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing
an osmotic diuresis leading to dehydration. This fluid loss must be replaced when it
becomes severe.
5.Karen who is the client with DM demonstrates acute anxiety when first
admitted for the treatment of hyperglycemia. The most appropriate intervention
to decrease the client’s anxiety would be to:
A. Administer a sedative
B. Make sure the client knows all the correct medical terms to understand what is
happening
C. Ignore the signs and symptoms of anxiety so that they will soon disappear
D. Convey empathy, trust, and respect toward the client
Correct answer: D
Rationale: The most appropriate intervention is to address the client’s feelings related
to anxiety.
6. . Glimepiride is prescribed for a client with diabetes mellitus. The nurse
instructs the client that which food items are most acceptable to consume while
taking this medication?
A. Alcohol, low calorie desserts, and whole grain cereals
B. Red meats, Whole-grain cereals, and carbonated beverages
C. Carbonated beverages, high calorie foods, and red meats
D. Whole grain cereals, alcohol, and carbonated beverages
Correct answer: B.
Rationale: When alcohol is combined with glimepiride, a disulfiram-like reaction
may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can
also potentiate the hypoglycemic effects of the medication. Clients need to be
instructed to avoid alcohol consumption while taking this medication. Low-calorie
desserts should also be avoided. Even though the calorie content may be low,
carbohydrate content is most likely high and can affect the blood glucose.
7. The home care nurse visits a client recently diagnosed with diabetes mellitus
who is taking Humulin NPH insulin daily. Karen, the client asks the nurse how
to store the unopened vials of insulin. The nurse should tell Karen to take which
action?
A. Freeze the insulin.
B. Refrigerate the insulin.
C. Store the insulin in a dark, dry place.
D. Keep the insulin at room temperature.
Correct answer: B.
Rationale: Insulin in unopened vials should be stored under refrigeration until
needed. Vials should not be frozen. When stored unopened under refrigeration, insulin
can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.
8.At the time Ruffa found out that the symptoms of diabetes were caused by high
levels of blood glucose, she decided to break the habit of eating carbohydrates.
With this, the nurse would be aware that the client might develop which of the
following complications?
A. Retinopathy
B. Atherosclerosis
C. Glycosuria
D. Acidosis
Correct answer: D.
Rationale: when a client’s carbohydrate consumption is inadequate, ketones are
produced from the breakdown of fat. These ketones lower the ph of the blood,
potentially causing acidosis that can lead to a diabetic coma.
9. Client Jaime has 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 the metabolism
of which of the following?
A. Carbohydrates only.
B. Fats and carbohydrates only.
C. Protein and carbohydrates only.
D. Proteins, fats, and carbohydrates.
Correct answer: D.
Rationale: Diabetes mellitus is a multifactorial, systemic disease associated with
problems in the metabolism of all food types. The client’s diet should contain
appropriate amounts of all three nutrients, plus adequate minerals and vitamins.
10. Which of the following is a priority nursing diagnosis for the diabetic client
who is taking insulin and has nausea and vomiting from a viral illness or
influenza?
A. Imbalanced nutrition: Less than body requirements.
B. Ineffective health maintenance related to ineffective coping skills.
C. Acute pain.
D. Activity intolerance.
Correct Answer:A.
Rationale: Imbalanced nutrition: Less than body requirements is a priority nursing
diagnosis for the client with diabetes mellitus who is experiencing vomiting with
influenza. The diabetic client should eat small, frequent meals of 50 g of carbohydrate
or food equal to 200 calories every 3 to 4 hours. If the client cannot eat the
carbohydrates or take fluids, the health care provider should be called, or the client
should go to the emergency department. The diabetic client is in danger of
complications with dehydration, electrolyte imbalance, and ketoacidosis. Increasing
the client’s coping skills is important to lifestyle behaviors, but it is not a priority
during this acute illness of influenza. Pain relief may be a need for this client, but it is
not the priority at this time; neither is intolerance for activity.
11. Nurse Alyana is explaining to the client about type 2 diabetes mellitus. The
risk factors of such condition include all of the following, except:
A. Advanced age
B. Physical inactivity
C. Obesity
D. Smoking
Correct answer: D.
Rationale: Additional risk factors for type 2 diabetes are a family history of diabetes,
impaired glucose metabolism, history of gestational diabetes, and race/ethnicity.
African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific
Islanders, and Native Americans are at greater risk of developing diabetes than
whites.
12. The nurse is working with an overweight client who has a high-stress job and
smokes. This client has just received a diagnosis of type 2 diabetes mellitus and
has just been started on an oral hypoglycemic agent. Which of the following
goals for the client which if met, would be most likely to lead to an improvement
in insulin efficiency to the point the client would no longer require oral
hypoglycemic agents?
A. Comply with medication regimen 100% for 6 months
B. Quit the use of any tobacco products by the end of three months
C. Lose a pound a week until the weight is within the normal range for height and
exercise 30 minutes daily
D. Practice relaxation techniques for at least five minutes five times a day for at least
five months
Correct answer: C.
Rationale: When Type II diabetics lose weight through diet and exercise they
sometimes have an improvement in insulin efficiency sufficient to the degree they no
longer require oral hypoglycemic agents.
13. Nurse Robedee is teaching an underweight and emaciated client about the
proper methods/techniques when giving insulin. Which one of the following
shows a proper technique?
A. Pinch the skin up and use a 90-degree angle
B. Use a 45-degree angle with the skin pinched up
C. Massage the area of injection after injecting the insulin
D. Warm the skin with a warm towel or washcloth prior to the injection
Correct answer: B.
Rationale: Insulin needs to be injected into the subcutaneous (fat layer) under the
skin.
14. True or false: One of the Nursing interventions of Diabetes Mellitus is to
explain the importance of weight gain to obese patients with diabetes.
A. True
B. False
Correct answer: B.
Rationale : Nursing Intervention of Diabetes Mellitus is to explain the importance of
weight loss to obese patients with diabetes.
15. During the lecture, Lozendo who is the clinical instructor tells the students
that 50% to 60% of daily calories should come from carbohydrates. What should
the nurse say about the types of carbohydrates that can be eaten?
A. Try to limit simple sugars to between 10% and 20% of daily calories.
B. Simple carbohydrates are absorbed more rapidly than complex carbohydrates.
C. Simple sugars cause a rapid spike in glucose levels and should be avoided.
D. Simple sugars should never be consumed by someone with diabetes.
Correct answer: A.
Rationale: It is recommended that carbohydrates provide 50% to 60% of the daily
calories. Approximately 40% to 50% should be from complex carbohydrates. The
remaining 10% to 20% of carbohydrates could be from simple sugars.
16. Client with a history of diabetes insipidus is admitted with polyuria,
polydipsia, and mental confusion. The priority intervention for this client is:
A. Weight the client
B. Encourage increased fluid intakes
C. Measure the urinary output
D. Check the vital signs
Answer: D
Rationale
The large amount of fluid loss can cause fluid and electrolyte imbalance that should
be corrected. The loss of electrolytes would be reflected in the vital signs. Measuring
the urinary output is important, but the stem already says that the client has polyuria.
Encouraging fluid intake will not correct the problem, .Weighing the client is not
necessary at this time.
17. Adequate fluid replacement and vasopressin replacement are objectives of
therapy for which of the following disease processes?
A. Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
B. Diabetes insipidus
C. Diabetes mellitus.
D. Diabetic ketoacidosis
Answer : B
Rationale
Maintaining adequate fluid and replacing vasopressin are the main objectives in
treating diabetes insipidus. An excess of antidiuretic hormone leads to SIADH,
causing the patient to retain fluid. Diabetic ketoacidosis is a result of severe insulin
insufficiency.
18. What are the typical presenting signs of diabetes insipidus?
A. Periorbital ecchymosis and blurred vision
B. Oliguria and hypoglycemia
C. Weight gain and malaise
D. Polyuria and polydipsia
Answer : A
Rationale
Due to decreased collecting tubule water reabsorption is induced by either decreased
secretion of antidiuretic hormone (ADH; central DI) or resistance to its renal effects
(nephrogenic DI).
19. Plan for a male client diagnosed with diabetes insipidus. The nurse should
include information about which hormone lacking in clients with diabetes
insipidus?
A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).
Answer : A
Rationale
ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and
LH levels won’t be affected.
20. 67-year-old male client has been complaining of sleeping more, increased
urination, anorexia, weakness, irritability, depression, and bone pain that
interferes with her going outdoors. Based on these assessment findings,
nurse Richard would suspect which of the following disorders?
A. Diabetes mellitus
B. Diabetes insipidus
C .Hyperparathyroidism
D. Hypoparathyroidism
Answer : C
Rationale
Hyperthyroidism is most common in older women and is characterized by bone pain
and weakness from excess parathyroid hormone (PTH). Clients also exhibit
hypercaliuria-causing polyuria. While clients with diabetes mellitus and diabetes
insipidus also have polyuria, they don’t have bone pain and increased sleeping.
Hypoparathyroidism is characterized by urinary frequency rather than polyuria.
21. The nurse is assessing a postcraniotomy client and finds the urine output
from a catheter is 1500 ml for the 1st hour and the same for the 2nd hour.
The nurse should suspect:
A. Diabetes mellitus
B. Adrenal crisis
C. Diabetes insipidus
D. Cushing’s syndrome
Answer : C
Rationale
Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in
clients after brain surgery.
22. Cyrill with severe head trauma sustained in a car accident is admitted to
the intensive care unit. Thirty-six hours later, the client's urine output
suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes
insipidus. Which laboratory findings support the nurse's suspicion of
diabetes insipidus?
A. Below-normal urine and serum osmolality levels
B. Above-normal urine osmolality level, below-normal serum osmolality
level
C. Above-normal urine and serum osmolality levels
D. Below-normal urine osmolality level, above-normal serum osmolality
level
Answer : D
Rationale
In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-
normal urine osmolality level. At the same time, polyuria depletes the body of water,
causing dehydration that leads to an above-normal serum osmolality level.
23. When caring for a male client with diabetes insipidus, nurse Juliet
expects to administer:
A. 10% dextrose.
B regular insulin.
C. furosemide (Lasix).
D vasopressin (Pitressin Synthetic).
Answer : D
Rationale
Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin)
production, the nurse should expect to administer synthetic vasopressin for hormone
replacement therapy.
24. You are preparing a 24-year-old patient with diabetes insipidus (DI) for
discharge from the hospital. Which statement indicates that the patient
needs additional teaching?
A “I will gradually wean myself off the vasopressin.”
B. “I will wear my medical alert bracelet at all times.”
C. “I will weigh myself every day using the same scale.”
D. “I will drink fluids equal to the amount of my urine output.”
Answer : A
Rationale
The patient with permanent DI requires life-long vasopressin therapy. All of the other
statements are appropriate to the home care of this patient.
25. A client with diabetes insipidus is taking Desmopressin acetate (DDAVP).
To determine if the drug is effective, the nurse should monitor the client’s:
A. Pulse rate
B. Arterial blood pH
C. Serum glucose
D. Intake and output
Answer : D
Rationale
DDAVP replaces the ADH, facilitating reabsorption of water and consequent return
of normal urine output and thirst.
26. A client is suspected of developing diabetes insipidus. Which of the
following is the most effective assessment?
A. Assessing ABG values every other day
B. Monitoring blood glucose
C. Taking vital signs every 4 hours
D Measuring urine output hourly
Answer : D
Rationale
Measuring the urine output to detect excess amount and checking the specific gravity
of urine samples to determine urine concentration are appropriate measures to
determine the onset of diabetes insipidus.
27. A male client with primary diabetes insipidus is ready for discharge on
desmopressin (DDAVP). Which instruction should nurse Lina provide?
A. “You may not be able to use desmopressin nasally if you have nasal
discharge or blockage.”
B. “You won’t need to monitor your fluid intake and output after you start
taking desmopressin.”
C. “Your condition isn’t chronic, so you won’t need to wear a medical
identification bracelet.”
D. “Administer desmopressin while the suspension is cold.”
Answer : A
Rationale
Desmopressin may not be absorbed if the intranasal route is compromised. Although
diabetes insipidus is treatable, the client should wear medical identification and carry
medication at all times to alert medical personnel in an emergency and ensure proper
treatment.
28. Which outcome indicates that treatment of a male client with diabetes
insipidus has been effective?
A. Blood pressure is 90/50 mm Hg.
B. Fluid intake is less than 2,500 ml/day.
C. Urine output measures more than 200 ml/hour.
D. The heart rate is 126 beats/minute.
Answer : B
Rationale
Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an
unusually high oral intake of fluids.
29. A patient with SIADH is undergoing IV treatment of a hypertonic IV
solution of 3% saline and IV Lasix. Which of the following nursing findings
requires intervention?
A. Sodium level of 136.
B. Patient reports urinating more frequently.
C. Potassium level of 5.0.
D. Assessment finding of crackles throughout the lung fields.
Answer : D
Rationale
Assessment finding of crackles throughout the lung fields. Remember that when
administering a hypertonic solution you have to do this very slowly and watch for
volume overload. Hypertonic solutions pull fluid from the cell (which is already water
intoxicated) and place it back into the vascular system...therefore, crackles in the
lungs are a sign there is too much fluid in the body and the heart can not compensate
so the fluid is backing up into the lungs. This would require intervention.
30. The urine of a patient with diabetes insipidus is most likely take on which
of the following appearances?
A. Smoky
B .Cloudy
C. Colorless
D. Dark amber
Answer : C
Rationale
Diabetes insipidus causes diuresis, which will result in dilute urine that will appear
colorless. Smoky urine is associated with hemoglobin or red blood cells in the urine,
cloudy urine is often indicative of an aged specimen, pyuria, bacteriuria, epithelial
cells, blood or leukocytes. Dark amber urine is indicative of concentrated urine related
to diminished urinary output.
