Which clinical manifestations of hypoglycemia would the nurse include when teaching a patient with diabetes?

Welcome to your ultimate diabetes NCLEX questions and review! Please answer all the diabetes mellitus practice questions (100 items) from our nursing test bank and test your competence in the nursing management of diabetes.

Diabetes Mellitus Nursing Test Bank

In this section is the practice NCLEX quiz for diabetes mellitus. This 100-item quiz will test your knowledge and ability to differentiate the different types of diabetes mellitus, recognizing the clinical manifestations and signs and symptoms of complications, medical management, nursing management, and patient education.

Quizzes included in this guide are:

1. Diabetes Mellitus NCLEX Practice | Quiz #1: 25 Questions
2. Diabetes Mellitus NCLEX Practice | Quiz #2: 25 Questions
3. Diabetes Mellitus NCLEX Practice | Quiz #3: 25 Questions
4. Diabetes Mellitus NCLEX Practice | Quiz #4: 25 Questions

Quiz guidelines:

1. Comprehend each item. Read and understand each question before choosing the best answer. The exam has no time limit so that you can make sense of each item at your own pace.
2. Review your answers. Once you’re done with all the questions, you’ll be redirected to the Quiz Summary table, where you’ll be able to review which questions you’ve answered or may have skipped. Review your answers once more before pressing the Finish Quiz button.
3. Read the rationales. After you have reviewed your answers, click on the Finish Quiz button to record your answers and show your score. Click on the View Questions button to review the quiz and read through the rationales for each question.
4. Let us know your feedback! Comment us your thoughts, scores, ratings, and questions about the quiz in the comments section below.

1. Diabetes Mellitus NCLEX Practice | Quiz #1: 25 Questions

Diabetes Mellitus NCLEX Practice | Quiz #1: 25 Questions

Here is the first part of your NCLEX practice questions for diabetes mellitus. Includes items. Please make sure to answer all other quizzes!

1. Diabetes Mellitus NCLEX Practice | Quiz #1: 25 Questions

Review Notes for Diabetes Mellitus

If you need a quick review around the concepts of diabetes mellitus, please see the refresher below:

Description

• Diabetes mellitus is a disorder characterized by insufficient production of insulin in the pancreas or when there is a resistance or deficiency of available insulin resulting in hyperglycemia.
• It is characterized by disturbances in carbohydrate, protein, and fat metabolism.
• Sustained hyperglycemia has been shown to affect almost all tissues in the body and is associated with significant complications of multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.

Types

• Type 1 diabetes mellitus or, formerly called insulin-dependent diabetes mellitus, typically occurs in younger people with the exact cause is unknown. Type 1 diabetes may result from an autoimmune process triggered by a virus 
• Type 2 diabetes mellitus, formerly called non-insulin dependent diabetes mellitus, is characterized by defects in insulin release and use, and insulin resistance. Commonly occurs in patients with obesity and those with genetic susceptibility to DM. 
• Gestational diabetes mellitus is characterized by glucose intolerance of any degree that occurs during pregnancy. 

Pathophysiology

• Type 1 diabetes mellitus: 
  • There is a destruction of the islet cells in the pancreas causing insufficient insulin and excess glucagon. 
  • Glucose accumulates in the serum causing hyperglycemia. 
  • Blood being delivered in the kidneys has high glucose concentration causing osmotic diuresis and glycosuria. 
  • Osmotic diuresis causes water loss, resulting in polydipsia. 
  • Lack of insulin makes the body unable to use carbohydrates primarily and instead uses fats and proteins for energy production, resulting in ketosis and weight loss. 
  • Polyphagia and fatigue result from the break down of nutritional stores. 
• Type 2 diabetes mellitus: 
  • Insulin resistance occurs in diabetes mellitus, wherein there is a decrease in tissue sensitivity to insulin. 
  • In normal conditions, insulin binds to special receptors on the cell surfaces and initiates reactions involved in glucose metabolism. However, in type 2 diabetes, these intracellular reactions are diminished, making insulin less effective at stimulating glucose uptake by the tissues and at regulating glucose release by the liver. 
  • If the beta cells cannot keep up with the increased demand for insulin, the glucose level rises and type 2 diabetes develops. 
• Gestational diabetes mellitus: 
  • Hyperglycemia develops in pregnancy because of the secretion of placental hormones, which causes insulin resistance. 
  • Gestational diabetes is related to the anti-insulin effects of progesterone, cortisol, and human placenta lactogen, which increase the amount of insulin needed to maintain glycemic control.

Complications

• Hypoglycemia is when the blood the glucose falls to less than 50 to 60 mg/dL and is linked to excessive use of hypoglycemic agents, decreased food intake, increased physical activity, excessive alcohol consumption, or renal failure. It often occurs before meals, especially if meals are delayed or snacks are omitted. It can occur on type 1 or type 2 diabetes. 
• Diabetic ketoacidosis (DKA) is caused by an absence or severe inadequacy of insulin. This deficit in available insulin results in disorders in the metabolism of carbohydrate, protein, and fat. DKA is usually associated with incorrect or failure to take insulin as prescribed and stress and is occurring in clients with type 1 diabetes. 
• Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) is the combination of severe hyperglycemia and hyperosmolarity with little or no acidosis. The insulin level in HHNS is too low to prevent hyperglycemia but is high enough to prevent fat breakdown. HHNS occurs in older clients (50 to 70 years old)  with type 2 diabetes and is associated with stress or ingestion of certain drugs. 
• Microangiopathy, or diabetic microvascular disease, is characterized by capillary basement membrane thickening most prominently in the retina and glomerulus. 
• Diabetic retinopathy is the deterioration of the small blood vessels that nourish the retina causing visual impairment. 
• Nephropathy is a renal dysfunction caused by microvascular changes in the kidney secondary to diabetes mellitus. 
• Diabetic neuropathy refers to a group of diseases that affect all types of nerves characterized by paresthesias or decreased sensation. Peripheral neuropathy and autonomic neuropathy are two of the most common types of neuropathy found in diabetes. 
• Increased susceptibility to infections results from an impaired ability of granulocytes to respond to infectious agents. 

Clinical Manifestations

• Diabetes mellitus: 
  • Polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased appetite) are the classic symptoms of diabetes mellitus, also known as the “3 P’s of DM”. 
  • Fatigue and weakness
  • Weight loss
  • Sudden vision changes
  • Tingling or numbness in hands or feet
  • Dry skin
  • Skin lesions or wounds that are slow to heal
  • Recurrent infections (urinary, skin, vulva)
• Diabetic Ketoacidosis (DKA)
  • Dehydration
  • Tachycardia
  • Kussmaul’s respirations
  • Nausea and vomiting
  • Abdominal pain
  • Acetone breath (fruity odor)
  • Decreased level of consciousness
  • Orthostatic hypotension
• Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
  • Dehydration (dry mucous membranes, poor skin turgor)
  • Decreased level of consciousness (altered sensorium, seizures, hemiparesis)
  • Tachycardia
  • Hypotension
• Hypoglycemia
  • Mild hypoglycemia: stimulation of the sympathetic nervous system. 
    • Sweating
    • Cool, moist skin, or pallor
    • Tremors
    • Tachycardia
    • Palpitation
    • Nervousness
    • Hunger
  • Moderate hypoglycemia: decreased glucose levels for the brain cells.
    • Impaired CNS function
    • Inability to concentrate
    • Lightheadedness
    • Headache
    • Confusion
    • Memory lapses
    • Double vision
    • Drowsiness
  • Severe hypoglycemia: severe impairment of the CNS.
    • Disoriented behavior
    • Seizures
    • Difficulty arousing from sleep
    • Loss of consciousness

Laboratory and Diagnostics

• Diabetes mellitus
  • Fasting blood glucose level above 140 mg/dL or postprandial (after meals) blood glucose levels above 200 mg/dl measured on more than one occasion is diagnostic. 
  • Glycosylated hemoglobin (HgbA1C) shows an elevated blood glucose level. 
• Diabetic ketoacidosis (DKA)
  • Blood glucose levels between 300 and 8900 mg/dL
  • Ketoacidosis is reflected in low serum bicarbonate (0 to 15 mEq/L) and low pH values. 
  • Accumulation of ketone bodies is reflected in blood and urine ketone measurements. 
  • Sodium and potassium concentrations may vary depending on the degree of dehydration. Increased levels of creatinine, blood urea nitrogen, and hematocrit go along with dehydration. 
  • Arterial blood gas indicate metabolic acidosis
• HHNS
  • Serum blood glucose higher than 700 mg/dL
  • Serum blood osmolality is higher than 350 mOsm/kg
  • Urine specimen reveals the absence of ketosis
  • Serum electrolyte levels show hypernatremia and hypokalemia. 
• Hypoglycemia
  • Serum blood glucose level is less than 70 mg/dL

Medical Management

• The main goal of treatment is to normalize insulin activity and blood glucose levels to reduce the development of complications. 
• There are five components of management for diabetes: nutrition, exercise, monitoring, pharmacologic therapy, and education. 
• Insulin is the primary treatment for type 1 diabetes. 
• Weight reduction is the primary treatment for type 2 diabetes. 
• Exercise enhances the effectiveness of insulin. 

Nursing Management

• Monitor blood glucose levels and provide teaching to the patient on how to do so. 
• Administer medications, as prescribed: 
  • Insulin for type 1 diabetes
  • Hypoglycemic agents for type 2 diabetes (sulfonylureas, thiazolidinediones, biguanides, alpha-glucosidase inhibitors)
• Self-administering insulin
  • Provide information and teaching on how to self-administer insulin. 
  • On storing insulin: vials of insulin, when not in use, should be refrigerated (extreme temperatures should also be avoided).  Insulin vial that is currently in use can be kept at room temperature (1 month). Cloudy insulins should be thoroughly mixed by gently inverting the vial or rolling it between the hands before drawing the solution. Intermediate-acting insulin showing a frosted, whitish coating inside the bottle, should be discarded. 
  • On selecting syringes: syringes should match the insulin concentration. 
  • On mixing insulins: patients should be warned not to inject one type of insulin into the bottle containing a different type of insulin. Patients with difficulty mixing insulins may use premixed insulin. 
  • Selecting and rotating injection sites: the abdomen, upper arms, thighs, and hips are the four main sites for insulin injection. Rotation of injection sites is recommended to prevent lipodystrophy which may cause a decrease in the absorption of insulin. Encourage the patient to use all available injection sites within one area rather than randomly rotating sites from area to area. 
  • Inserting the needle: insulin should be injected into the subcutaneous tissue, the incorrect technique may affect the rate of absorption. 
• Nurse teaching on diabetes
  • Assess readiness to learn and include the patient’s family in developing a diabetic teaching plan. 
  • Prevention of complications
  • Dietary and lifestyle changes
  • Proper self-care (especially foot care)
  • Administration and management of insulin
  • Use of hypoglycemic medications
• Management of  DKA. 
  • Treatment goal is to prevent dehydration, electrolyte loss, and acidosis. 
  • Normal saline (0.9%) is infused at a high rate to replace fluid loss. Hypotonic solution (0.45% NS) may be used for hypertension or hypernatremia. 
  • Administer regular insulin, as ordered.
  • Monitor serum glucose levels as insulin is administered. 
  • Monitor potassium levels, because potassium shifts affect the heart. 
  • Monitor respirations as respiratory distress can occur. 
  • Assess vital signs, intake and output, and monitor ketone levels. 
• Management of HHNS. 
  • Assess vital signs, fluid status, and laboratory values. Fluid status and urine output are closely monitored because of the risk for renal failure secondary to severe dehydration. 
  • Because clients are usually older, monitor for heart failure and cardiac arrhythmias.
• Management of Hypoglycemia. 
  • Monitor blood glucose levels. 
  • Administer glucose (oral glucose, I.V. glucose, or glucagon). 
  • Advise client to carry simple sugar at all times to prevent case of hypoglycemia. 

Recommended Resources

Recommended books and resources for your NCLEX success:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

• Saunders Comprehensive Review for the NCLEX-RN (8th Edition)
  The most comprehensive and complete NCLEX exam review book with over 5,200 NCLEX-style questions that are thoroughly updated to reflect the most recent test plan.
• Saunders Q & A Review for the NCLEX-RN® Examination (8th Edition)
  This popular review offers more than 6,000 test questions, giving you all the Q&A practice you need to pass the NCLEX-RN examination! Each question enhances review by including a test-taking strategy and rationale for correct and incorrect answers.
• NCLEX-RN Prep Plus by Kaplan (24th Edition)
  Kaplan’s NCLEX-RN Prep Plus uses expert critical thinking strategies and targeted sample questions to help you put your expertise into practice and face the exam with confidence.
• Illustrated Study Guide for the NCLEX-RN Exam
  Using colorful illustrations and fun mnemonic cartoons, the Illustrated Study Guide for the NCLEX-RN® Exam, 10th Edition brings the concepts found on the NCLEX-RN to life!
• NCLEX RN Examination Prep Flashcards
  Easy to use flash cards developed by test prep books for test takers trying to achieve a passing score on the NCLEX RN test, these flashcards cover.
• Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX-RN Examination
  This book is the first and the most popular NCLEX-RN Exam review book focused exclusively on building management-of-care clinical judgment skills.
• Saunders Comprehensive Review for the NCLEX-PN Examination (8th Edition)
  The book includes a review of all nursing content areas, more than 4,500 NCLEX exam-style questions, detailed rationales, test-taking tips and strategies, and new Next-Generation NCLEX (NGN)-style questions.
• More NCLEX review books here.

Recommended Links

An investment in knowledge pays the best interest. Keep up the pace and continue learning with these practice quizzes:

• Nursing Test Bank: Free Practice Questions UPDATED!
  Our most comprehenisve and updated nursing test bank that includes over 3,500 practice questions covering a wide range of nursing topics that are absolutely free!
• NCLEX Questions Nursing Test Bank and Review UPDATED!
  Over 1,000+ comprehensive NCLEX practice questions covering different nursing topics. We’ve made a significant effort to provide you with the most challenging questions along with insightful rationales for each question to reinforce learning.

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.