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Exam 1 (MedSurg) - Diabetes

Total questions: 100

Worksheet time: 52mins

Name
Class
Date
1.

Diabetes Mellitus is a chronic, multisystem disease related to abnormal ______ production, impaired ______ utilization, or both.

a)

insulin

b)

glucose

c)

protein

d)

lipid

2.

Diabetes Mellitus is a leading cause of which of the following?

a)

Adult blindness

b)

End-stage kidney disease

c)

Nontraumatic lower limb amputations

d)

All of the above

3.

Major contributing factors of Diabetes Mellitus include:

a)

Heart disease

b)

Stroke

c)

Hypertension (HTN)

d)

All of the above

4.

Normal insulin metabolism is produced by beta cells in the islets of ______.

a)

Langerhans

b)

Kupffer

c)

Bowman

d)

Meissner

5.

Insulin is released continuously into the bloodstream in small increments with larger amounts released after ______.

a)

food

b)

exercise

c)

sleep

d)

medication

6.

Insulin stabilizes glucose level in the range of ______ mg/dL.

a)

70-120

b)

120-180

c)

40-70

d)

180-250

7.

Which of the following is NOT a function of insulin?

a)

Promotes glucose transport in skeletal muscle and adipose tissue

b)

Stores glucose as glycogen

c)

Inhibits gluconeogenesis

d)

Stimulates gluconeogenesis

8.

Which hormones are considered counterregulatory hormones?

a)

Glucagon, epinephrine, growth hormone, cortisol

b)

Insulin, glucagon, thyroxine, epinephrine

c)

Cortisol, insulin, adrenaline, growth hormone

d)

Epinephrine, thyroxine, insulin, glucagon

9.

Counterregulatory hormones oppose the effects of insulin.

a)

True

b)

False

10.

Fill in the blanks: Counterregulatory hormones stimulate ______ production by the _____.

a)

glucose, liver

b)

insulin, pancreas

c)

protein, kidneys

d)

fatty acid, pancreas

11.

Which of the following is NOT a class of diabetes mellitus?

a)

Type 1

b)

Type 2

c)

Gestational

d)

Insipidus

12.

Type 1 Diabetes Mellitus is formerly known as _______.

a)

juvenile-onset or insulin-dependent diabetes

b)

adult-onset or non-insulin-dependent diabetes

c)

gestational diabetes

d)

maturity-onset diabetes of the young

13.

Type 1 Diabetes Mellitus accounts for what percentage of all diabetes cases?

a)

1%

b)

5%

c)

10%

d)

20%

14.

Type 1 Diabetes Mellitus is characterized by AUTOIMMUNE destruction of ______ cells.

a)

beta

b)

alpha

c)

delta

d)

gamma

15.

Type 1 Diabetes Mellitus is associated with total absence of _______.

a)

insulin

b)

glucagon

c)

adrenaline

d)

thyroxine

16.

Onset of Type 1 Diabetes Mellitus usually occurs in people younger than what age?

a)

20 years

b)

30 years

c)

40 years

d)

50 years

17.

Autoantibodies are present for months to years before symptoms occur in Type 1 Diabetes Mellitus.

a)

True

b)

False

18.

Type 2 Diabetes Mellitus makes up what percentage of diabetes cases?

a)

10-20%

b)

50-60%

c)

90-95%

d)

100%

19.

Which of the following are risk factors for Type 2 Diabetes Mellitus?

a)

Overweight

b)

Obesity

c)

Advancing age

d)

Family history

e)

All of the above

20.

Type 2 Diabetes Mellitus is NOT increasingly prevalent in children due to socioeconomic and sociocultural factors.

a)

True

b)

False

21.

In Type 2 Diabetes Mellitus, the pancreas continues to produce some endogenous insulin.

a)

True

b)

False

22.

Insulin in Type 2 Diabetes Mellitus is:

a)

Sufficient and well utilized

b)

Insufficient or poorly utilized

c)

Not produced at all

d)

Overproduced

23.

What is the greatest risk factor for Type 2 Diabetes Mellitus?

a)

Hypertension

b)

Obesity

c)

Genetics

d)

Tachycardia

24.

Genetic components increase ______ in Type 2 Diabetes Mellitus.

a)

insulin resistance

b)

insulin secretion

c)

glucose absorption

d)

pancreatic function

25.

Which of the following is NOT a major metabolic abnormality in Type 2 Diabetes Mellitus?

a)

A) Insulin resistance

b)

B) Increased insulin production by pancreas

c)

C) Inappropriate hepatic glucose production

d)

D) Altered production of hormones and cytokines by adipose tissue

26.

Metabolic syndrome increases risk for Type 2 Diabetes Mellitus. Which of the following is NOT a component of metabolic syndrome?

a)

A) Elevated glucose levels

b)

B) Abdominal obesity

c)

C) Elevated BP

d)

D) Low cholesterol

27.

What is the fasting glucose level range for impaired fasting glucose (IFG)?

a)

80 to 99 mg/dL

b)

100 to 125 mg/dL

c)

126 to 140 mg/dL

d)

140 to 199 mg/dL

28.

Impaired glucose tolerance (IGT) is diagnosed by a 2 hour oral glucose tolerance test (OGTT) with glucose levels between _______.

a)

140 to 199 mg/dL

b)

100 to 125 mg/dL

c)

200 to 299 mg/dL

d)

70 to 99 mg/dL

29.

Gestational diabetes develops during pregnancy.

a)

True

b)

False

30.

Usually glucose levels return to normal ______ weeks postpartum in gestational diabetes.

a)

6

b)

2

c)

12

d)

20

31.

50% of women with gestational diabetes will become diabetic.

a)

True

b)

False

32.

Patient education for prediabetes includes which of the following?

a)

Undergo screening

b)

Manage risk factors

c)

Monitor for symptoms of diabetes

d)

All of the above

33.

Which symptom is described as excessive thirst in T1DM?

a)

Polyphagia

b)

Polyuria

c)

Polydipsia

d)

Fatigue

34.

Fill in the blank: Polyphagia is defined as excessive ________ in T1DM.

a)

hunger

b)

thirst

c)

urination

d)

sweating

35.

Which diagnostic test is used to reflect glucose levels over the past 2-3 months in DM?

a)

Fasting blood glucose

b)

Hemoglobin A1C test

c)

Oral glucose tolerance test

d)

Urine glucose test

36.

Fill in the blank: The goal for Hemoglobin A1C in DM management is ________%.

a)

6.5-7

b)

8-9

c)

7.5-8

d)

5-5.5

37.

Fill in the blank: All patients with T1DM require _______.

a)

insulin

b)

metformin

c)

dietary fiber

d)

statins

38.

Fill in the blank: Rapid acting insulin has an onset of _______ minutes.

a)

10-30

b)

60-120

c)

120-180

d)

180-240

39.

Which of the following is an example of short acting insulin?

a)

Lispro

b)

Humalog

c)

Humulin N

d)

Glulisine

e)

Novolin R

40.

Fill in the blank: Human insulin is genetically engineered in _______.

a)

laboratories

b)

hospitals

c)

farms

d)

factories

41.

Which of the following is prescribed for patients with T2DM who cannot control their blood glucose by any other means?

a)

Exogenous insulin

b)

Nutritional therapy

c)

Bariatric surgery

d)

Drug therapy

e)

Endogenous insulin

42.

What is the onset time for intermediate acting insulin?

a)

1.5-4 hr

b)

5-10 min

c)

10-20 hr

d)

30-60 min

43.

Which of the following is an example of intermediate acting insulin?

a)

Glargine

b)

Humulin N

c)

Detemir

d)

Lantus

e)

Novolin R

44.

What is the peak time for long acting insulin?

a)

No pronounced peak

b)

12-24 hours

c)

40-60 hours

d)

8-10 hours

45.

What is the duration of action for rapid acting bolus insulin?

a)

15 minutes

b)

1 hour

c)

4 hours

d)

8 hours

46.

When should rapid or short-acting insulin be administered in relation to meals?

a)

BEFORE meals (bolus)

b)

AFTER meals (bolus)

c)

DURING meals (bolus)

d)

WITHOUT regard to meals

47.

Which insulin regimen most closely mimics endogenous insulin production?

a)

Basal-bolus regimen

b)

Mealtime insulin regimen

c)

Intermediate acting regimen

d)

Long acting regimen

48.

How often is intermediate or long acting background insulin administered in a basal-bolus regimen?

a)

Once or twice a day

b)

Every meal

c)

Every hour

d)

Once a week

49.

Short acting bolus insulin should be injected how many minutes before a meal?

a)

30-45 minutes

b)

5-10 minutes

c)

60-90 minutes

d)

Immediately before meal

50.

What is the primary use of background (basal) insulin?

a)

To control BG levels in between meals and overnight

b)

To treat acute hypoglycemia

c)

To control BG levels with meals

d)

To reduce cholesterol

51.

Long acting basal insulin should be administered:

a)

Once or twice a day

b)

Every 4 hours

c)

Only at night

d)

Every meal

52.

Long acting basal insulin can be mixed with other insulins or solutions.

a)

True

b)

False

53.

What is the duration of intermediate acting basal insulin (NPH)?

a)

4-6 hrs

b)

12-18 hrs

c)

24 hrs

d)

1-2 hrs

54.

What is the peak time for intermediate acting basal insulin?

a)

1-2 hrs

b)

4-12 hrs

c)

12-18 hrs

d)

No peak

55.

Intermediate acting basal insulin can be mixed with short and rapid acting insulins.

a)

True

b)

False

56.

What must be done before mixing intermediate acting basal insulin?

a)

Heat it

b)

Freeze it

c)

Agitate to mix

d)

Add water

57.

Combination insulin therapy provides coverage for:

a)

Only mealtime (bolus)

b)

Only background (basal)

c)

Both mealtime (bolus) and background (basal)

d)

Only rapid acting insulin

58.

In-use insulin vials may be left at room temperature for up to 4 weeks.

a)

True

b)

False

59.

Extra insulin should be _________?

a)

Refrigerated

b)

Heated

c)

Kept at room temperature

d)

Frozen

60.

Prefilled syringes should be stored upright for 1 week if they contain 2 insulin types, and for 30 days for single insulin type.

a)

True

b)

False

61.

How is insulin typically administered?

a)

Transmucosal tablet

b)

Subcutaneous injection

c)

Oral tablet

d)

Intramuscular injection

62.

Regular insulin may be given IV.

a)

True

b)

False

63.

Although it is preferred to use parenteral routes (SQ, IV) for insulin, it can be given orally as well.

a)

True

b)

False

64.

Absorption of insulin is fastest from which site?

a)

Abdomen

b)

Arm

c)

Thigh

d)

Buttock

65.

What should you do with injection sites to prevent complications?

a)

Rotate injections within one particular site

b)

Always use the same spot for injections

c)

Inject at random sites without any pattern

d)

Never change the injection site

66.

How many units of insulin are in 1 mL?

a)

100 units

b)

10 units

c)

50 units

d)

500 units

67.

Should alcohol swab be used for self-injection of insulin?

a)

No

b)

Yes, always

c)

Only if the needle is new

d)

Only if injecting insulin

68.

What should the patient use to wash the site before self-injection of insulin?

a)

Soap and water

b)

Alcohol swab

c)

Just water

d)

Hand sanitizer

e)

Normal saline

69.

At what angle should insulin be injected?

a)

45-90 degrees

b)

0-15 degrees

c)

120-180 degrees

d)

90-180 degrees

70.

How many RNs must check the insulin dosage?

a)

Two

b)

One

c)

Three

d)

Four

71.

Insulin pumps provide continuous subcutaneous infusion.

a)

True

b)

False

72.

Where is the catheter of an insulin pump inserted?

a)

Into subcutaneous tissue in the abdominal wall

b)

Into a vein in the arm

c)

Directly into the stomach

d)

Into the muscle of the thigh

73.

What is the Somogyi Effect?

a)

Rebound effect in which an overdose of insulin causes hypoglycemia, and the body's response is to release counterregulatory hormones, causing hyperglycemia.

b)

Rebound effect in which an overdose of glucagon causes hypoglycemia, and the body's response is to release insulin, causing hyperglycemia.

c)

A phenomenon where blood glucose remains stable despite insulin administration

d)

Rebound effect in which an overdose of insulin causes hyperglycemia, and the body's response is to release counterregulatory hormones, causing hypoglycemia.

74.

Lipodystrophy is common in patients with an insulin ______, and causes complete or partial loss of ____ tissue in abnormal regions of the body.

a)

IM injection, ghrelin

b)

bolus, adipokine

c)

pump, adipose

d)

regimen, endocrine

75.

What is the ADA approved diet for improved metabolic control in diabetic patients also known as in a hospital setting?

a)

no sugar

b)

heart healthy

c)

clear liquid

d)

carb control

e)

cirrhosis

76.

Type 1 diabetics can have more dietary flexibility if they utilize ____ acting insulin, multiple daily injections, and ____ pumps.

a)

long, GLP-1

b)

short, insulin

c)

rapid, insulin

d)

rapid, glucagon

e)

short, GLP-1

77.

SATA: Select all of the healthy carbohydrate choices for diabetics.

a)

fruits

b)

vegetables

c)

whole grains

d)

legumes

e)

low-fat milk

78.

What is a good dietary source of polyunsaturated fatty acids for diabetic patients?

a)

Two or more Wendy's 4 for $4 deals per week

b)

Two or more servings of steamed beets per week

c)

Two or more servings of fish per week

d)

Two or more servings of raw pork per week

e)

Two or more apples per week

79.

In regards to exercise, diabetic patients should ideally perform resistance training at least __ times per week.

a)

5

b)

10

c)

3

d)

20

80.

Exercise promotes a glucose-lowering effect that can last up to ________.

a)

24 hours

b)

2 weeks

c)

48 hours

d)

12 hours

e)

1 week

81.

If a patient is labeled as "ACHS", what does that mean in regards for when blood glucose levels should be checked?

a)

check BG only if hypoglycemia is suspected

b)

check BG two hours after all meals

c)

check BG every 6 hours

d)

check BG before meals and at bedtime

e)

check BG right when the patient wakes up in the morning

82.

SATA: Which lab values would the RN expect to be high in a patient with diabetes mellitus?

a)

triglycerides

b)

A1C

c)

LDLs

d)

HDLs

e)

VLDLs

83.

SATA: What would indicate a patient is presenting with diabetic ketoacidosis?

a)

oral glucose tolerance test in excess of 200 mg/dL

b)

leukocytosis

c)

increased BUN

d)

ketones in the urine

e)

severe bradycardia

84.

For intraoperative diabetic patients, it is important to continuously monitor glucose because prior to the procedure, the patient ___________.

a)

was on a clear liquid diet

b)

was made NPO after midnight the day prior

c)

will have severe hyperglycemic episodes while under anesthesia

d)

needs large doses of long acting insulin before anesthesia is given

85.

Diligent _____ care is a vital teaching point the RN should explain to diabetic patients before they discharge.

a)

nose

b)

hair

c)

foot

d)

hand

86.

SATA: What are some consequences of untreated hypoglycemia?

a)

loss of consciousness

b)

seizures

c)

coma

d)

death

e)

retinopathy

87.

Choose the BEST answer: The RN should avoid _____ of hypoglycemia.

a)

undertreatment

b)

overtreatment

c)

treatment

d)

documentation

88.

When initially treating moderate hypoglycemia, the RN should have the patient consume _____ grams of a _____ carbohydrate, and recheck the patients blood glucose in _____ minutes.

a)

10, complex, 15

b)

50, simple, 10

c)

15, simple, 15

d)

5, complex, 30

89.

SATA: What are some treatment options for severe, emergent hypoglycemia in the acute care setting?

a)

50% Dextrose IVP

b)

Humulin N SQ

c)

Metformin PO

d)

Glucagon IM/SQ

e)

Lispro IVP/SQ

90.

What is the leading cause of diabetes mellitus-related death?

a)

retinopathy

b)

neuropathy

c)

angiopathy

d)

infection complications

91.

Cerebrovascular, cardiovascular, and peripheral vascular diseases are all types of _______ angiopathy than can result from diabetes mellitus.

a)

microvascular

b)

macrovascular

c)

minivascular

d)

megavascular

92.

SATA: Which of the following are microvascular angiopathies that can result from diabetes mellitus?

a)

retinopathy

b)

nephropathy

c)

neuropathy

d)

dermopathy

e)

gastroparesis

93.

Diabetic retinopathy is the leading cause of new cases of adult _______.

a)

pressure ulcers

b)

amputations

c)

myocardial infarctions

d)

blindness

94.

The leading cause of end-stage kidney disease is diabetic ______.

a)

nephropathy

b)

retinopathy

c)

alcoholism

d)

demyelination

95.

What percentage of diabetic patients experience some degree of neuropathy?

a)

40-50%

b)

10-20%

c)

60-70%

d)

70-100%

96.

Due to reduced nerve conduction, patients suffering from distal symmetric polyneuropathy lose protective _____ in the ________ and are at major risk for _______.

a)

paresthesias, upper extremities, caries

b)

sensation, lower extremities, amputation

c)

sensation, upper extremities, cardiac arrest

d)

paresthesias, lower extremities, hypertensive crisis

97.

SATA: Select all of the adverse effects that can be caused by diabetic autonomic neuropathy.

a)

gastroparesis

b)

postural hypotension

c)

erectile dysfunction

d)

neurogenic bladder

e)

painless myocardial infarction

98.

Infection is a chronic complication of diabetes mellitus because of defects in the mobilization of _____ cells and impaired _____.

a)

endocrine, gluconeogenesis

b)

inflammatory, phagocytosis

c)

gastric, emptying times

d)

neuronal, myelination

99.

The RN should consider diabetes mellitus when a patient is presenting with RECURRING ______ infections.

a)

respiratory

b)

yeast

c)

protozoic

d)

archaea

e)

buccal

100.

SATA: Select the reasons below that contribute to why glycemic control can be more difficult for the elderly.

a)

increased hypoglycemic unawareness

b)

functional limitations

c)

renal insufficiency

d)

poor hearing and vision

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