1. A nurse is preparing a presentation for a local community group about diabetes.

Which
of the following would the nurse include when describing type 1 diabetes? Select all that
apply.
A) Insidious onset
B) Occurs before age 20
C) Insulin supplementation required for survival
D) Formally known as non-insulin-dependent diabetes mellitus
E) Obesity a risk factor
Ans: B, C
Feedback:
Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has
a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in
insufficient amounts and therefore must have insulin supplementation to survive. Type 1
diabetes is an autoimmune disorder; therefore, obesity is not a risk factor.

2. The nurse is assessing a client for risk factors associated with type 2 diabetes. Which of
the following would the nurse identify? Select all that apply.
A) Younger age
B) Impaired glucose tolerance
C) Caucasian race
D) Obesity
E) History of gestational diabetes
Ans: B, D, E
Feedback:
A nurse should be able to identify all the risk factors for type 2 diabetes in a client.
These include obesity, older age, family history of diabetes, history of gestational
diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity
(African Americans, Hispanic/Latino Americans, Native Americans, and some Asian
Americans).

3. A nurse is preparing to administer a long-acting insulin to a client. Which of the

4. After teaching an in-service presentation to a group of nurses about diabetes and insulin,

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 the presenter determines that the presentation was successful when the group identifies
which of the following as a rapid-acting insulin? Select all that apply.
A) Insulin aspart (NovoLog)
B) Isophane insulin suspension (Novolin N)
C) Insulin glargine (Lantus)
D) Insulin detemir (Levemir)
E) Insulin glulisine (Apidra)
Ans: A, E
Feedback:
Insulin aspart (NovoLog) and insulin glulisine (Apidra) are rapid-acting insulins.
Isophane insulin suspension is an intermediate-acting insulin. Insulin glargine and
detemir are long-acting insulins.

5. A nurse is caring for a client receiving insulin glargine (Lantus) 20 units at bedtime.
Initiation of which of the following drugs may increase the client's insulin requirement?
Select all that apply.
A) Methylprednisolone (Medrol)
B) Metoprolol (Lopressor)
C) Fenofibrate (Tricor)
D) Estradiol (Estrace)
E) Niacin (Niaspan)
Ans: A, D, E
Feedback:
Corticosteroids (methylprednisolone), estrogens (estradiol), and niacin (Niaspan) are
among the drugs can decrease the effect of insulin and require an increase in insulin
dosage to control the client's diabetes. Beta blockers and fibrates increase the effect of
insulin and thus may require a decrease in the dosage of insulin.

6. A nurse is caring for a client receiving insulin detemir 10 units at bedtime. Which of the
following drugs, if started, would most likely require a decrease in the dosage of
insulin?
Select all that apply.
A) Sulfamethoxazole/trimethoprim (Septra)
B) Metoprolol (Lopressor)
C) Fenofibrate (Tricor)
D) Diltiazem (Verapamil)
E) Albuterol (Ventolin)
Ans: A, B, C
Feedback:
Sulfonamides (sulfamethoxazole/trimethoprim), beta-blocking drugs (metoprolol), and
fibrates (fenofibrate), among others, can increase the effect of insulin and require a
decrease in insulin dosage to control the client's diabetes. Diltiazem and albuterol
decrease the effect of insulin, requiring an increase in the dosage.

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 7. After administering insulin detemir to a client with diabetes, the nurse suspects that the
client is developing hypoglycemia based on assessment of which of the following?
Select all that apply.
A) Increased thirst
B) Increased urination
C) Headache
D) Confusion
E) Diaphoresis
Ans: C, D, E
Feedback:
The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation,
confusion, headache, diplopia, convulsions, dizziness, unconsciousness, hunger, nausea,
diaphoresis, and numbness or tingling of the lips or tongue. Increased thirst and
urination suggest hyperglycemia.

8. As part of the ongoing assessment of a client receiving insulin detemir, the nurse would
suspect that the insulin is not effective based on assessment of which of the following?
Select all that apply.
A) Increased thirst
B) Increased urination
C) Increased appetite
D) Confusion
E) Abdominal pain
Ans: A, B, E
Feedback:
If the insulin was not effective, the client would exhibit signs and symptoms of
hyperglycemia including drowsiness, dim vision, thirst, nausea, vomiting, abdominal
pain, loss of appetite, acetone breath, and excessive urination.

9. When preparing to administer insulin glargine to a client, which of the following would
be appropriate for the nurse to do? Select all that apply.
A) Check the expiration date on the vial.
B) Shake the vial vigorously.
C) Check the physician's orders for the type and dosage of insulin.
D) Remove all air bubbles from the syringe barrel.
E) Mix with short-acting insulin prior to administration.
Ans: A, C, D
Feedback:
Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the
following preadministration steps: carefully check the physician's order for the type and
dosage of insulin, check the expiration date on the vial, gently rotate the vial between
the palms of the hands, gently tilt end to end before withdrawing the insulin, and
remove all air bubbles from the syringe barrel. The nurse should never mix or dilute

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 insulin glargine (Lantus) with any other insulin or solution because the insulin will not
be effective.

10. The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has
become confused, diaphoretic, and nauseated. The nurse checks the client's blood
glucose and it is 60 mg/dL. Which of the following would the nurse most likely give?
Select all that apply.
A) Orange or other fruit juice
B) Glucose tablets
C) Insulin glargine (Lantus)
D) Hard candy
E) Insulin detemir (Levemir)
Ans: A, B, D
Feedback:
Methods of terminating a hypoglycemic reaction include the administration of one or
more of the following: orange or other fruit juice, hard candy or honey, glucose tablets,
glucagon, or glucose 10% or 50% IV.

11. A nurse is preparing to administer a drug that helps lower blood glucose by increasing
the production of insulin by beta cells in the pancreas. Which of the following might this
be? Select all that apply.
A) Glyburide (DiaBeta)
B) Metformin (Glucophage)
C) Pioglitazone (Actos)
D) Glipizide (Glucotrol)
E) Acarbose (Precose)
Ans: A, D
Feedback:
Sulfonylureas, like glyburide (DiaBeta) and glipizide (Glucotrol), help lower blood
glucose by increasing the production of insulin by beta cells in the pancreas.

12. After teaching a group of nursing students about antidiabetic drugs, the instructor
determines that the teaching was successful when the students identify which of the
following as producing the glucose-lowering effects by delaying the digestion and
absorption of carbohydrates in the intestine? Select all that apply.
A) Glimepiride (Amaryl)
B) Metformin (Glucophage)
C) Pioglitazone (Actos)
D) Miglitol (Glyset)
E) Acarbose (Precose)
Ans: D, E
Feedback:
The alpha-glucosidase inhibitors, acarbose (Precose) and miglitol (Glyset), produce

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 their glucose-lowering effects by delaying the digestion and absorption of carbohydrates
in the intestine. Glimepiride is a sulfonylurea. Metformin sensitizes the liver to
circulating insulin levels and reduces hepatic glucose production. Pioglitazone decreases
insulin resistance and increases insulin sensitivity by modifying several processes,
resulting in decreased hepatic glucogenesis (formation of glucose from glycogen) and
increased insulin-dependent muscle glucose uptake.

13. Which of the following produce their glucose-lowering effect by decreasing insulin
resistance and increasing insulin sensitivity? Select all that apply.
A) Rosiglitazone (Avandia)
B) Metformin (Glucophage)
C) Pioglitazone (Actos)
D) Miglitol (Glyset)
E) Acarbose (Precose)
Ans: A, C
Feedback:
The thiazolidinediones, rosiglitazone (Avandia) and pioglitazone (Actos), produce their
glucose-lowering effect by decreasing insulin resistance and increasing insulin
sensitivity. The alpha-glucosidase inhibitors, acarbose (Precose) and miglitol
(Glyset), produce their glucose-lowering effects by delaying the digestion and
absorption of carbohydrates in the intestine. Metformin sensitizes the liver to
circulating insulin levels and reduces hepatic glucose production.

14. After administering glimepiride, the nurse would assess the client for which of the
following? Select all that apply.
A) Lactic acidosis
B) Edema
C) Hypoglycemia
D) Heartburn
E) Nausea
Ans: C, D, E
Feedback:
Adverse reactions associated with sulfonylureas, like glimepiride (Amaryl), include
hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain,
heartburn, and various vague neurologic symptoms, such as numbness and weakness of
the extremities.

15. A client is receiving metformin (Glucophage). The nurse suspects that the client is
developing lactic acidosis based on assessment of which of the following? Select all that
apply.
A) Malaise
B) Hypertension
C) Tachypnea

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D) Abdominal pain
E) Muscular pain
Ans: A, C, D, E
Feedback:
Symptoms of lactic acidosis include malaise, abdominal pain, tachypnea, shortness of
breath, and muscular pain.

16. A nurse should monitor a client taking glyburide (DiaBeta) for increased hypoglycemic
effect if which of the following drugs are initiated? Select all that apply.
A) Ranitidine (Zantac)
B) Warfarin (Coumadin)
C) Digoxin (Lanoxin)
D) Lithium (Eskalith)
E) Amitriptyline (Elavil)
Ans: A, B, E
Feedback:
H2 antagonists (ranitidine), anticoagulants (warfarin), and tricyclic antidepressants
(amitriptyline), among others, can result in increased hypoglycemic effects of
sulfonylureas (glyburide).

17. A client is receiving glyburide. The nurse assesses the client for a decrease in the drug's
effect if which of the following drugs are initiated? Select all that apply.
A) Atenolol (Tenormin)
B) Amlodipine (Norvasc)
C) Phenytoin (Dilantin)
D) Lithium (Eskalith)
E) Levothyroxine (Synthroid)
Ans: A, B, C, E
Feedback:
Beta blockers (atenolol), calcium channel blockers (amlodipine), hydantoins
(phenytoin), and thyroid agents (levothyroxine), among others, can result in decreased
hypoglycemic effects of sulfonylureas (glyburide).

18. A client at a health care facility has been prescribed diazoxide for hypoglycemia due to
hyperinsulinism. After administration, the nurse would assess the client for which
adverse reaction?
A) Myalgia
B) Tachycardia
C) Flatulence
D) Epigastric discomfort
Ans: B
Feedback:
The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid

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 retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving
diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions
observed in clients undergoing pioglitazone HCl drug therapy. Flatulence is one of the
adverse reactions found in clients receiving metformin drug therapy. Epigastric
discomfort is one of the adverse reactions observed in clients receiving acetohexamide
drugs.

19. A client has been prescribed acarbose. Which of the following interventions should the
nurse perform to promote an optimal response to the medication?
A) Administer the drug with breakfast.
B) Expect to add an oral sulfonylurea with the drug.
C) Administer the drug with the first bite of the meal.
D) Report unusual somnolence to the primary health care provider.
Ans: C
Feedback:
The nurse should administer acarbose to the client with the first bite of the meal. The
nurse needs to administer glyburide (Micronase) with breakfast. An oral sulfonylurea
will likely be added to metformin if the client does not experience a response in 4 weeks
using the maximum dose of metformin. Clients taking metformin may experience
unusual somnolence, of which the nurse should inform the primary health care provider.

20. A client is receiving glipizide at a health care facility. The client is also prescribed an
anticoagulant. The nurse would be alert for which of the following related to the
interaction of these two drugs?
A) Increased risk of lactic acidosis
B) Risk of acute renal failure
C) Increased risk for bleeding
D) Increased hypoglycemic effect
Ans: D
Feedback:
The nurse should observe for increased hypoglycemic effect in the client as the effect of
the interaction of sulfonylureas with the anticoagulants, chloramphenicol, clofibrate,
fluconazole, histamine-2 antagonists, methyldopa, monoamine oxidase inhibitors
(MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of
lactic acidosis is an effect of the interaction of metformin with glucocorticoids.
Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-
infective drugs. There is a risk of acute renal failure when iodinated contrast material
used for radiologic studies is administered with metformin.

21. A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic
drug. Which of following ongoing assessments should the nurse perform when caring
for this client?
A) Assess the skin for ulcers, cuts, and sores.

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B) Observe the client for hypoglycemic episodes.
C) Monitor the client for lipodystrophy.
D) Document family medical history.
Ans: B
Feedback:
As the ongoing assessment activity, the nurse should observe the client for
hypoglycemic episodes. Documenting family medical history and assessing the client's
skin for ulcers, cuts, and sores should be completed before administering the drug.
Lipodystrophy occurs if the sites of insulin injection are not rotated.

22. A nurse is assigned to administer insulin glargine to a client at a health care facility.
What precaution should the nurse take when administering this drug?
A) Administer glargine via IV route.
B) Avoid mixing glargine with other insulin.
C) Shake the vial vigorously before withdrawing insulin.
D) Be sure the insulin has been refrigerated.
Ans: B
Feedback:
When administering insulin glargine to the client, the nurse should avoid mixing it with
other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is
mixed with another solution, it will lose glucose control, resulting in decreased
effectiveness of the insulin. Glargine is administered via the subcutaneous route once
daily at bedtime. The nurse should not shake the vial vigorously before withdrawing
insulin. The vial should be gently rotated between the palms of the hands and tilted
gently end to end immediately before withdrawing the insulin. The nurse administers
insulin from vials at room temperature. Vials are stored in the refrigerator if they are to
be stored for about 3 months for later use.

23. A nurse at a health care facility is assigned to administer insulin to the client. Which of
the following interventions should the nurse perform before administering each insulin
dose?
A) Inspect the previous injection site for inflammation.
B) Keep prefilled syringes horizontally.
C) Check for symptoms of myalgia or malaise.
D) Mix the insulin with sterile water in the syringe.
Ans: A
Feedback:
The nurse should check the previous injection site before administering each insulin
dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes
should not be kept horizontally; they should be kept in a vertical or oblique position to
avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when
administration of metformin leads to lactic acidosis. Insulin should not be mixed with
other drugs in the syringe. Some types of insulin may be combined in one syringe, but
sterile water is never used.

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 24. A nurse is caring for a client who has developed a hypoglycemic reaction. Which of the
following interventions should the nurse perform if swallowing and gag reflexes are
present in the client?
A) Administer glucagon by the parenteral route.
B) Administer the insulin via insulin pump.
C) Administer oral antidiabetics to the client.
D) Give oral fluids or candy.
Ans: D
Feedback:
The nurse should administer oral fluids or candy to the hypoglycemic client with
swallowing and gag reflexes. If the client is unconscious, the nurse should administer
glucose or glucagon parenterally. The nurse should administer insulin through an insulin
pump for diabetic clients who are pregnant or have had a renal transplant. Oral
antidiabetic drugs are administered to clients with type 2 diabetes.

25. A nurse is caring for a client diagnosed with type 2 diabetes. When teaching the client
about this condition, the nurse would identify which of the following as a risk factor?
A) Young age
B) Regular exercise
C) Obesity
D) Polyuria
Ans: C
Feedback:
The nurse informs the client that obesity is a risk factor associated with type 2 diabetes.
Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a
symptom of diabetes and not a risk factor leading to type 2 diabetes.

26. A nurse is caring for a client with type 2 diabetes receiving a meglitinide. The nurse
reviews the client's medical record based on the understanding that which condition
would contraindicate the use of this drug?
A) Diabetic ketoacidosis
B) Kidney disease
C) Severe heart failure
D) Liver disease
Ans: A
Feedback:
Meglitinides are contraindicated in clients with diabetic ketoacidosis and severe
endocrine disease. Thiazolidinediones are contraindicated in clients with severe heart
failure and used with caution in clients with kidney disease, severe heart failure, and
liver disease.

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 27. A client receives insulin lispro at 8 a.m. The nurse would be alert for signs and
symptoms of hypoglycemia at about which time?
A) 8:15 a.m.
B) 9 a.m.
C) 10 a.m.
D) 11 a.m.
Ans: B
Feedback:
Insulin lispro reaches its peak action in 30 minutes to 1.5 hours. Therefore, the client's
greatest risk for hypoglycemia would be during this time or about 9 a.m. Onset of action
occurs in 5 to 10 minutes, so the drug would begin being effective at this time.

28. A client who is receiving metformin develops lactic acidosis. When planning the care
for this client, which nursing diagnosis would the nurse most likely identify?
A) Ineffective Breathing Pattern
B) Risk for Fluid Volume Deficit
C) Acute Confusion
D) Anxiety
Ans: A
Feedback:
When taking metformin, the patient is at risk for lactic acidosis manifested by
unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence.
Thus, a nursing diagnosis of Ineffective Breathing Pattern would be most likely. There
are no problems with fluid balance. Acute Confusion would be appropriate if the client
was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly
diagnosed with diabetes and having difficulty accepting the diagnosis.

29. A client is being discharged after being diagnosed with diabetes. The client is being
taught how to monitor his blood glucose. After teaching the client, which statement
indicates to the nurse that additional teaching is needed?
A) “I should prick the tip of my finger to get the blood.”
B) “I should clean my finger with warm, soapy water.”
C) “I should massage my finger to get a hanging drop of blood.”
D) “I should avoid smearing the blood on the test strip.”
Ans: A
Feedback:
The client should insert the lancet to prick the side of the finger, not the tip, because the
side has more capillaries and fewer nerve endings. The finger should be washed with
warm, soapy water and then dried before testing. The client should massage the finger to
get a hanging drop of blood to be placed on the test strip. The client needs to avoid
smearing the blood on the strip to prevent inaccurate readings.

30. A client is prescribed miglitol. The nurse would instruct the client to administer this

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 drug at which time?
A) At bedtime
B) Three times a day with the first bite of a meal
C) 30 minutes before eating breakfast
D) Before or after a meal during the day
Ans: B
Feedback:
Miglitol is given three times a day with the first bite of the meal because food increases
absorption.

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