EXAM 4

Question 1

The lab results for an older patient indicate a glycosylated hemoglobin (HbA1c) result of 6.5%. What is the nurse’s best response to the patient?

1. “Your blood sugar levels have been within normal limits for the past three months.”
2. “Your HbA1c level indicates a pattern of low blood glucose levels.”
3. “Your HbA1c indicates that you are anemic and will require a blood transfusion.”
4. “Your average blood glucose level averaged 126 mg/dl over the past 3 months, which is high.”

Answer 1

4

Glycosylated hemoglobin estimates a patient’s blood glucose over the past 3 months by measuring how much glucose is attached to the hemoglobin in red blood cells, which have an average life span of about 4 months. An HbA1c of 6.5 relates to an average glucose level of 126 mg/dl. A normal glycosylated hemoglobin result is 5.0%.

Question 2

The nurse is planning interventions to achieve the goal of maintaining glycemic control for an older patient with type 2 diabetes mellitus. Which interventions will the nurse include in this patient’s plan of care? Select all that apply.

1. Teach to prevent hypoglycemia.
2. Emphasize the role of physical exercise.
3. Review the manifestations of complications.
4. Stress the importance of avoiding carbohydrates.
5. Instruct in self-monitoring of blood glucose levels.

Answer 2

1,2,3,5

Question 3

Why should the nurse counsel an older patient with a history of occasional high blood glucose levels to stop smoking?

1. To prevent need for HgA1C monitoring
2. To prevent rapid weight gain
3. To reduce the risk of developing type 2 diabetes mellitus
4. To reduce the risk of insulin dependence

Answer 3

3

Question 4

The nurse is caring for an older patient with type 2 diabetes mellitus. What is the teaching priority for this patient?

1. Provide written instructions in large print
2. Create a plan for hypoglycemic episodes
3. Provide instructions for good skin care
4. Educate regarding diabetic foot care

Answer 4

2

Question 5

5) While conducting a health interview the nurse suspects an older patient might be experiencing diabetes. What comment did the patient make that could indicate this diagnosis?
1. “I sometimes have muscle aches in my upper legs at night.”
2. “I feel a bit tired by midafternoon and take a 30-minute nap most days.”
3. “I’ve been experiencing blurred vision frequently during the past month.”
4. “I’m slightly winded when I walk up a flight of stairs but it passes quickly.”

Answer 5

3

Question 6

Which dietary guideline would be important for the nurse to instruct a patient with diabetes mellitus?

1. Include foods rich in calcium at every meal.
2. Eliminate as much fat from the diet as possible.
3. Eat at regular times including meals and snacks.
4. Ingest the majority of daily caloric intake in the morning meal.

Answer 6

3

Question 7

An older male patient with type 2 diabetes mellitus wants to know if he can have an alcoholic drink. What information should the nurse provide about alcohol intake with diabetes? Select all that apply.

1. Ingest alcohol with food.
2. Alcohol can interact with diabetes medications.
3. Consider calories from alcohol as being fat calories.
4. Limit consumption to no more than two drinks per day.
5. Double oral hypoglycemic medications when consuming alcohol.

Answer 7

1,2,3,4

Question 8

The healthcare provider suggests that an older patient with type 2 diabetes mellitus begin a walking program. What should the nurse include when teaching the patient about this program? Select all that apply.

1. Dress in layers.
2. Wear shoes with thick flexible soles.
3. Walk at least three to five times a week.
4. Wear a music headset to block noise distractions.
5. Perform warm-up exercises before walking.

Answer 8

1,2,3,5

Question 9

Metformin has been prescribed for an older patient with renal insufficiency and a new diagnosis of type 2 diabetes mellitus. What is the nurse’s priority action?

1. Begin instruction on a new medication regime.
2. Hold the Metformin and contact the healthcare provider.
3. Obtain a fasting blood sugar prior to administration.
4. Instruct the patient on subcutaneous injections.

Answer 9

2

Question 10

An older patient diagnosed with type 2 diabetes mellitus has been prescribed a combination of long and short-acting insulin. What should be included in the nurse’s medication instruction?

1. Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing.
2. When medications are mixed together it is cost-effective, using only one syringe per administration time.
3. Insulin mixtures allow the medication to be distributed more deeply into the subcutaneous layer of tissue and allow for better absorption.
4. Insulin combinations reduce the incidence of complications to the patient and to the injection site.

Answer 10

1

Question 11

The home health nurse assesses signs of hypoglycemia in an older patient. Which factors could cause this phenomenon? Select all that apply.

1. An illness
2. Poor sleep routine
3. Missing a meal
4. Unplanned exercise
5. Too much medication

Answer 11

1,3,4,5

Question 12

The nurse is performing an admission assessment on an older patient with type 2 diabetes mellitus. Which assessment data is a risk factor for hypothyroidism? Select all that apply.

1. Taking oral furosemide (Lasix) for hypertension
2. Medical history of non-thyroid autoimmunity
3. Previous external radiation for neck cancer
4. Taking acetaminophen (Tylenol) routinely for arthritis pain
5. Compliance with 1800 calorie American Diabetes Association (ADA) diet

Answer 12

1,2,3

Question 13

An older patient has been diagnosed with hyperthyroidism. Which treatment will the nurse anticipate?

1. Partial thyroidectomy
2. Ingestion of radioactive sodium iodine
3. Combination treatment with Synthroid and amiodarone
4. Large doses of propylthiouracil (PTU) and intravenous propranolol

Answer 13

2

Question 14

The healthcare provider has ordered a monofilament test on a patient with diabetes mellitus. What should be included in the nurse’s instruction?

1. “A monofilament test is used to detect retinopathy in patients with diabetes.”
2. “A monofilament test will assess feeling and sensations in different parts of your feet.”
3. “A monofilament test will detect elevated blood glucose levels and ketones in the blood.”
4. “A monofilament test will indicate weak or absent peripheral pulses in your feet.”

Answer 14

2

Question 15

An older patient with type 2 diabetes mellitus has a capillary blood glucose level of 44 mg/dL. What is the nurse’s priority action? What should the patient ingest to provide an immediate source of carbohydrate?

1. Provide four ounces of orange juice to the patient.
2. Glucose level is normal so no action is required.
3. Ask the patient when they last ate a meal.
4. Offer three to five pieces of sugar-free candy

Answer 15

1

Question 16

The nurse is preparing a teaching plan for a patient with type 2 diabetes mellitus regarding proper foot care. Which instructions should the nurse include in this plan? Select all that apply.

1. See a podiatrist for nail care.
2. Lubricate dry areas with lotion.
3. Dry moist areas between the toes.
4. Use an emery board to smooth toenails.
5. Soak feet in warm water to soften nails before clipping.

Answer 16

1,2,3,4

Question 17

The nurse is preparing discharge teaching for an older patient receiving insulin injections for diabetes. What should the nurse teach the patient about the insulin?

1. Always keep insulin refrigerated.
2. Systematically rotate insulin injection sites.
3. Increase the amount of insulin before exercise.
4. Ketones in the urine signify a need for less insulin.

Answer 17

2

Question 18

The nurse is performing a blood glucose test on an older patient with type 2 diabetes mellitus. Which are manifestations of hyperglycemia? Select all that apply.

1. Fatigue
2. Dizziness
3. Blurred vision
4. Abdominal pain
5. Excessive urination

Answer 18

1,3,4,5

Question 19

During a home visit the nurse learns that an older patient with type 2 diabetes mellitus and chronic renal failure is experiencing headache, polydipsia, and lethargy. What is the most important assessment that the nurse should make at this time?

1. Measure the patient’s latest urine output.
2. Assess the patient’s appetite and oral intake.
3. Measure the patient’s current capillary blood glucose level.
4. Determine the amount of fluid the patient has ingested over the last few hours.

Answer 19

3

Question 20

The nurse teaches an older patient with type 2 diabetes mellitus how to manage their diabetes when becoming acutely ill with a cold or other infection. Which statements indicate that instruction has been effective? Select all that apply.

1. “I should call the doctor if I have severe diarrhea.”
2. “My blood glucose levels will not change when I’m ill.”
3. “I should change my oral meds to insulin if I’m vomiting.”
4. “A large amount of ketones in my urine is to be expected.”
5. “I should not take my medication if I can’t eat and call the doctor.”

Answer 20

1,5

Question 21

The nurse is caring for an older patient with hypothyroidism. Which manifestations would the nurse anticipate? Select all that apply.

1. Dry skin
2. Weight loss
3. Vomiting
4. Bradycardia
5. Periorbital swelling

Answer 21

1,2,4,5

Question 22

The nursing instructor asks a student to describe Graves disease. Which statement by the student indicates an accurate understanding of this disorder?

1. “The antibodies in Graves disease bind to receptors on the thyroid cells and weaken them.”
2. “It is an autoimmune disorder associated with sustained thyroid overactivity.”
3. “It is an autoimmune disorder associated with severe thyroid underactivity.”
4. “It is associated with a tumor on the thyroid, which leads to thyroid overactivity”

Answer 22

2

Question 23

The nurse is caring for an older patient experiencing new-onset atrial fibrillation. Which lab result is most concerning?

1. Hgb 13.8 g/dL
2. Hgb 11.0 g/dL
3. TSH 18 mU/mL
4. TSH 0.25 mU/mL

Answer 23

4

This is an abnormally low TSH level, which is a diagnostic indicator of hyperthyroidism that could be the cause for the patient’s new-onset atrial fibrillation.

Question 24

A 75-year-old patient is newly diagnosed with type 2 diabetes mellitus and asks why it developed late in life. What is the nurse’s best response?

1. “This disease is inevitable since everyone over 70 years will develop diabetes.”
2. “The pancreas becomes hardened and unable to produce insulin with aging.”
3. “The body loses the ability to digest carbohydrates as a normal part of aging.”
4. “The body gradually reduces the production of insulin as a normal part of aging.”

Answer 24

4

Question 25

The nurse is teaching management of type 2 diabetes mellitus to a group of older adults. Which participant statement indicates that additional instruction is needed?

1. “I will keep some hard candy with me at all times.”
2. “I will start a walking program with my neighbors.”
3. “If I’m sick, I will call my doctor to see if I should take my medicine.”
4. “If I start to feel nervous, sweaty, or shaky, I will drink a glass of water.”

Answer 25

4

Question 26

What are the normal changes in Endocrine?

Answer 26

1. decrease insulin secretion
2. decrease insulin sensitivity
3. potential for thyroid function problems with systemic symptoms
4. Peripheral tissues may become insulin resistant
   (obesity)

Question 27

True or False

Diabetes is the 7th leading cause of death

Answer 27

True

Question 28

Autoimmune disease – insulin dependent

Answer 28

Type 1 diabetes mellitus

Question 29

Type 1 diabetes mellitus

Answer 29

➢ Immune system destroys pancreatic beta cells
o β cells make insulin (regulates blood
glucose)

➢ Pancreatic destruction secondary to a viral infection
(i.e. mumps, measles, rubella, influenza, and
encephalitis)

Question 30

Insulin resistance – cells cannot use insulin properly
90-95%; older age, obesity, family history, physical inactivity,
race/ethnicity

Answer 30

Type 2 diabetes mellitus

Question 31

term for retinal damage
➢ Loss of vision or blindness (macular degeneration)
➢ Ophthalmic exam

Answer 31

retinopathy

Question 32

term for kidney damage

Answer 32

nephropathy

Question 33

term for nerve damage

Answer 33

neuropathy