A 32 year old multigravida at 28 weeks comes in to the A 32 year old multigravida at 28 weeks comes into the

clinic. She has given birth three times, once at 35 clinic. Her screenings for GDM are positive. The
weeks (twins), once at 38 weeks (singleton), and once patient asks how she will know if she has high blood
at 41 weeks (singleton). All children are alive and well. sugar. Which response should the nurse give? (select
She had one spontaneous abortion at 10 weeks. How all)
should the nurse record her obstetrical history using
GTPAL designation? a. hyperglycemia often presents as increased thirst
and urination
a. 3-2-0-1-3 b. hyperglycemia causes a headache and flushed,
b. 4-1-1-1-2 dry skin
c. 5-2-1-1-4 c. hyperglycemia causes cool and clammy skin
d. 4-2-1-0-2 d. hyperglycemia causes an increased sensation of
being hungry

A 32 year old multigravida at 28 weeks comes into the

A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for GDM are positive. She asks
clinic. The nurse notes her fasting 1 hour glucose about content and timing of her meals How should the
screening level is 164 mg/dL. Which information does nurse advice? (select all)
the nurse recognize in the client's history to support a
diagnosis of gestational diabetes? a. eliminate the bedtime snack if heartburn develops
b. choose complex carbs that are high in fiber
a. maternal great-aunt has non-insulent Type-2 c. increase the protein if anemia develops
diabetes d .avoid foods high in refined sugar
b. Child weighed 9 lbs (4.08 kg) at 41 weeks e. drink between 8 to 10 cups of fluid daily
gestation
c. Trace of protein noted in the urine
32 year old multigravida at 28 weeks comes into the
d. client is 64 in tall and weighs 134 prior to pregnancy
clinic. Her screenings for GDM are positive. Which
instructions should the diabetes educator include
regarding fingerstick blood glucose monitoring?
A 32 year old multigravida at 28 weeks comes into the
clinic. The nurse notes her fasting 1 hour glucose
a. check fasting blood sugar at lunch
screening level is 164 mg/dL. She is scheduled for a 3
b. prior to breakfast and before each meal
hour oral glucose tolerance test. Which special
c. two hours after all meals, at bedtime, and in the
instructions in addition to fasting 8 hour before the
middle of the night
appointment should the nurse give?
d. once a day at dinner

A 32 year old multigravida at 36 weeks comes into the

a. only coffee or tea is allowed once the fasting level
clinic. Her screenings for GDM are positive. She
has been drawn
manages GDM with diet. She has decreased fetal
b. follow an unrestricted diet and exercise pattern
movement is is admitted to antepartum for a nonstress
for 3 days before the test
test and biophysical profile. Which fetal heart rate
c. write down questions and call the lab the day before
changes indicate a reactive nonstress test?
the test
d. smoking in moderation is allowed up to the time the
a. persistent late decelerations associated with three
test begins
uterine contractions, lasting 40 to 60 seconds each in a
10 minute period
b. increase in fetal heart rate baseline to 170 bpm,
A 32 year old multigravida at 28 weeks comes into the lasting for 20 minutes
clinic. Her screenings for GDM are positive. The c. marked variability in fetal heart rate in response to
patient asks why she wasnt tested until 28 weeks. The contractions caused by nipple stimulation
nurse's response should be based on the d. two episodes of acceleration (greater than 15
understanding of which normal physiologic change of beats/minute, lasting more than 15 seconds) related to
pregnancy? fetal movement in a 20 minute period

a. maternal insulin crosses the placenta to regulate A 32 year old multigravida at 36 weeks comes into the
fetal glucose levels throughout the pregnancy clinic. Her screenings for GDM are positive. She
b. in the first trimester, estrogen and progesterone manages GDM with diet. She has decreased fetal
movement is is admitted to antepartum for a nonstress
cause an increase in fasting glucose levels
test and biophysical profile. She has a nonreactive
c. hormonal changes in the second and third nonstress test. her total BPP score is 6: 2 for fetal
trimester increase the maternal insulin resistance movement, 0 for gross body movement, 2 for fetal
d. fetal insulin increases each trimester, forcing the tone, 0 for nonreactive nonstress test, and 2 for
mother's body to produce more glucose
qualitative amniotic fluid volume. For this reason, the c. request a change in prescription
doctor orders an amniocentesis. Which action should d. substitute medication with fewer side effects
the nurse take first?
A 32 year old multigravida at 36 weeks with GDM
a. administer Rh immune globulin (RhoGAM) if the spontaneously ruptures. She is 8 cm dilated, fully
client is Rh negative effaced, and at 0 station and received the pain
b. assist the client to the bathroom and ask her to medication stadol. The nurse is called away to care for
empty her bladder a 29 week gestation with painless vaginal bleeding.
c. apply the external fetal monitor to evaluate uterine The nurse is concerned for the care of her 28 week
contractility gestation, but the charge nurse says there is no one
d. clean the abdomen with betadine solution and sterile else. What should the nurse do?
4x4
a. care for both clients
A 32 year old multigravida at 36 weeks comes into b. call the clients HCP
antepartum with decreased fetal movement and GDM. c. contact the nursing supervisor
An amniocentesis reveals fetal lung maturity and an d. refuse to care for either client
induction is scheduled for the next morning. The next
morning she complains of uterine discomfort and A 32 year old multigravida at 36 weeks with GDM
contractions every 10 minutes, her membranes rupture spontaneously ruptures, is complete and feels a strong
spontaneously. Which action by the nurse takes urge to push. The fetal heart rate indicates moderate
priority? variability and a baseline of 145 bpm. After three
pushes the head is crowning. The head is born over an
a. notify the OB intact perineum, but rotates externally and retracts
b. transfer patient to a labor and delivery recovery suite back against the perineum. The nurse and OB
c. reapply the external fetal monitor to evaluate the recognize these as signs of a should dystocia. Which
fetal heart rate immediate action should the nurse take?
d. start an IV using an 18 or large IV catheter
a. notify the operating room to prepare for c/s
A 32 year old multigravida at 36 weeks with GDM b. apply external pressure to the fundus
spontaneously ruptures. The patients husband asks c. administer 0.25 mg terbutaline (brethine) subq
why blood sugar is maintained between 70 and 90. d. reposition the client using McRobert's maneuver
What nurse response is best?
A 32 year old multigravida at 36 weeks with GDM
a. more insulin will be available for fetal use via spontaneously ruptures. She has a shoulder dystocia
placental transfer in which the nurse performed the McRobert's and the
b. a glucose level more than 90-100 puts the client at OB performed an episiotomy. The baby is born 9 lb 9
risk for infection oz, the 1 minute apgar is 1 and the 5 minute apgar is
c. an elevated glucose in labor increases the risk for 9. Stimulation and flow by oxygen was used for 1
neonatal hypoglycemia minute. Which newborn behavior would indicate to the
d. maintaining euglycemia in labor decreases the need nurse that the infant has suffered a complication from
for insulin postpartum the shoulder dystocia?

A 32 year old multigravida at 36 weeks with GDM a. unilateral absence of the moro reflex
spontaneously ruptures. She is 6 cm dilated and b. one eye remains open when crying
requests pain medication, but not an epidural. The c. positive babinksi reflex bilaterally
nurse gets an order for 1 mg IV tartrate (stadol). Which d. presence of caput succedaneum
assessment information is most important for the nurse
to validate with the laboring client before giving the A 32 year old multigravida at 36 weeks with GDM
medication? spontaneously ruptures. She has a shoulder dystocia
in which the nurse performed the McRobert's and the
a. past or present history of opioid dependence OB performed an episiotomy. The newborn's
b. length of all previous labor experiences assessment is normal. The mother is worried about the
c. herbal preparation use during pregnancy baby developing hypoglycemia. What should the nurse
d. previous use of analgesia or anesthesia in labor recommend for feeding?

a. The baby needs formula to prevent hypoglycemia

A 32 year old multigravida at 36 weeks with GDM and jaundice
spontaneously ruptures. She is 6 cm dilated and b. the newborn needs breast milk and 5% dextrose in
requests pain medication, but not an epidural. The water
nurse gets an order for 1 mg IV tartrate (stadol). The c. breastfeeding should be initiated immediately and
patient would like one half of the prescribed dose of done on demand
butorphanol tartrate (stadol). What action should the d. a mixture of breastmilk and formula will prevent
nurse take? complications

a. administer one half the dose as requested b. b. Tell A 32 year old multigravida at 36 weeks with GDM
the client that she must take the whole dose delivers and is transferred to postpartum 2 hours after
delivery. In postpartum there is a new graduate RN, an results of certain tests
RN with 3 years of experience, and an RN with 10 d. it is important to use another method of
years of experience as well as a LPN with 20 years of contraception prior to starting the mini pill
experience. Which client should the charge nurse e. the medication may be taken with food if the
assign to the LPN?
side effect of nausea occurs when ingested on an
a. the 32 year old multigravida with GDM and empty stomach
breasfeeding problems
b. a multigravida who had an uncomplicated delivery A 34-year-old female is currently 16 weeks pregnant.
and is breastfeeding You're collecting the patient's health history. She has
c. a primigravida who had a c/s 4 hours ago and is the following health history: gravida 5, para 4, BMI 28,
bottle feeding hypertension, depression, and family history of Type 2
d. a primigravida who is 12 hours posteclamptic diabetes. Select below all the risk factors in this
seizure and is bottle feeding scenario that increases this patient's risk for
developing gestational diabetes?
A charge nurse hears another nurse give
misinformation about RhoGam. Which information A. 34-years-old
should the nurse give about the RhoGam injection? B. 16 weeks pregnant
C. Gravida 5, para 4
a. RhoGam is given to the infant 48 hours after D. BMI 28
delivery E. Hypertension
b. RhoGam is given to the mother within 72 hours of F. Depression
delivery if the infant is Rh positive G. Family history of Type 2 diabetes
c. RhoGam is a vaccine given to a mother with Rh-
positive blood within 24 hours of delivery When do most patients tend to develop gestational
d. RhoGam is given at 18 weeks gestation to mothers diabetes during pregnancy?
with Rh-negative blood
A. usually during the 1-3 month of pregnancy
Where will the nurse expect to palpate the uterine B. usually during the 2-3 month of pregnancy
fundus two hours post birth? C. usually during the 1-2 trimester of pregnancy
D. usually during the 2-3 trimester of pregnancy
a midline at the umbilicus
b. midline 2 cm above the umbilicus You're providing an educational class for pregnant
c. shifted left at the umbilicus women about gestational diabetes. You discuss the
d. shifted right 4 cm below umbilicus role of insulin in the body. Select all the CORRECT
a (the fundus will be midline after birth for 24 hours. A statements about the role and function of insulin:
fundus above the umbilicus or shifted right or left may
indicate blood in the uterus or a full bladder) A. "Insulin is a type of cell that provides glucose to the
body from the blood."
A 32 year old multigravida at 36 weeks with GDM B. "Insulin is a hormone secreted by the beta cells of
delivers. She asks why insulin was discontinued after the pancreas."
the baby was born. How should the nurse respond? C. "Insulin influences cells by causing them to uptake
glucose from the blood."
a. most women with GDM return to normal glucose D. "Insulin is a protein that helps carry glucose into the
levels after birth cell for energy."
b. sliding scale insulin will be needed for 6 weeks
postpartum A 32-year-old female is diagnosed with gestational
c. breastfeeding increases the need for insulin and so diabetes. As the nurse you know that what test below
you will need a pump is used to diagnose a patient with this condition?
d. oral hypoglycemics will be started as soon as the
client is eating a regular diet A. 1 hour glucose tolerance test
B. 24 hour urine collection
A 32 year old multigravida at 36 weeks with GDM C. Hemoglobin A1C
D. 3 hour glucose tolerance test
delivers. Which information is the most important
for the nurse to discuss concerning the use of A 36-year-old pregnant female is diagnosed with
contraception while breast feeding? (select all) gestational diabetes at 28 weeks gestation. You're
educating the patient about this condition. Which
a. irregular vaginal bleeding (breakthrough statement by the patient demonstrates they
bleeding) is not unusual when using this understood your teaching about gestational diabetes?
medication and usually lessens over time
b. if a dose is taken more than 3 hours late, a A. "Once I deliver the baby, it will go away, and I will
backup method birth control must be used for 48 not need any further testing."
hours B. "It is important I try to get my fasting blood glucose
around 70-95 mg/dL and <140 mg/dL 1 hour after
c. it is important to notify lab personnel that this
meals."
medication is being used because it alters the C. "There are no risks or complications related to
gestational diabetes other than hyperglycemia." B. Confusion
D. "I'm at risk for delivering a baby that is too small for C. Frequent hunger
its gestational age due to this condition." D. Polydipsia
E. Anxiety
Fill-in the blank: When a woman develops gestational F. Frequent urination
diabetes it is during a time in the pregnancy when
insulin sensitivity is _____________. This is majorly When are most pregnant patients tested for gestational
influenced by hormones such as estrogen, diabetes?
progesterone, _______________ and
_______________. A. 6-12 weeks gestation
B. 12-20 weeks gestation
A. high; prolactin and human chorionic gonadotropin C. 24-28 weeks gestation
(hCG) D. 34-36 week gestation
B. low; estriol and human placental lactogen (hPL)
C. high; human chorionic gonadotropin (hCG) and A patient completes a one hour glucose tolerance test.
cortisol The patient's result is 190 mg/dL. As the nurse you
D. low; human placental lactogen (hPL) and cortisol know that the next step in the patient's care is to?

Your patient is 36 weeks pregnant and has gestational A. Continue monitoring pregnancy, the test is normal
diabetes. Which lab result below is euglycemic? B. Reassess blood glucose in 2 weeks
C. Notify the physician who will order the patient to
A. Blood glucose 55 mg/dL take a 3 hour glucose tolerance test
B. Blood glucose 82 mg/dL D. Provide education to the patient about how to
C. Blood glucose 148 mg/dL manage gestational diabetes during pregnancy
D. Blood glucose 325 mg/dL
A patient has a 3 hour glucose tolerance test
A patient has gestational diabetes and is currently 34 performed. The results are the following: Fasting 94
weeks pregnant. Which assessment findings below mg/dL, 1 hour 210 mg/dL, 2 hour 180 mg/dL, 3 hour
should you immediately report to the physician? Select 130 mg/dL. Identify which results are abnormal: Select
all that apply: all that apply:

A. Blood glucose 129 mg/dL A. Fasting result

B. Blood pressure 190/102 B. 1 hour result
C. Proteinuria C. 2 hour result
D. Linea nigra D. 3 hour result
E. Negative glycosuria
You educate a pregnant patient with gestational
A patient is 35 weeks pregnant. She has gestational diabetes that she should try to have a blood glucose
diabetes and uncontrolled hyperglycemia. Her current level of ______________ 1 hour after a meal.
blood glucose is 290 mg/dL. You administer insulin per
physician's order and recheck the blood glucose level A. <70 mg/dL
per protocol. It is now 135 mg/dL. Which statement by B. <250 mg/dL
the patient requires you to notify the physician? C. >160 mg/dL
D. <140 mg/dL
A. "It burns when I urinate."
B. "My back is hurting." You're discharging a patient who just gave birth to a
C. "I feel tired." baby at 39 weeks gestation. The patient had
D. "I feel the baby kick about 10 times an hour." gestational diabetes throughout her pregnancy. Her
blood glucose levels have now returned to normal.
A baby is born at 37 weeks gestation to a mother with When should the patient first follow-up with her
gestational diabetes. As the nurse you know at birth physician for blood glucose testing?
that the newborn is at risk for? Select all that apply:
A. 1-3 years
A. Hyperglycemia B. 6-12 weeks postpartum
B. Hypoglycemia C. 1 year postpartum
C. Respiratory distress D. Not applicable since this condition has resolved and
D. Jaundice only occurs during pregnancy
E. Hyperthermia
A primip diagnosed with type 1 dm reviews the insuliln
You're teaching a pregnant mother with gestational regimen with the nurse. The nurse explains which
diabetes about the signs and symptoms of changes in insulin requirements will occur in
hyperglycemia. What are the signs and symptoms you pregnancy?
will include in your education to the patient? Select all
that apply: a. insulin requirements will increase during pregnancy
and decrease after delivery
A. Sweating b. insulin requirements will decrease during pregnancy
and increase after delivery d. Insulin injections may be necessary.
c. insulin requirements will increase during pregnancy e. The baby will likely be born with diabetes
and remain increased after delivery f. The mother should strive to gain no more weight
d. insulin requirements decrease during pregnancy during the pregnancy.
and remain decreased after delivery

When a pregnant woman with diabetes experiences The goal for pre-prandial blood glucose for those with
hypoglycemia while hospitalized, what should the Type 1 diabetes mellitus is:
nurse have the woman do?
a. <80 mg/dl
a. Eat a candy bar. b. < 130 mg/dl
b. Eat 5 or 6 hard candies or drink 8 oz of milk. c. <180 mg/dl
c. Drink 4 oz of orange juice followed by 8 oz of d. <6%
milk.
d. Drink 8 oz of orange juice with 2 teaspoons of
sugar added.
e. The guidelines for Carbohydrate Counting as medical
A pregnant woman has maternal phenylketonuria nutrition therapy for diabetes mellitus includes all of the
(PKU) and is interested in whether or not she will be following EXCEPT:
able to breastfeed her baby. Which statement made by
the nurse indicates accurate information? a. Flexibility in types and amounts of foods consumed
b. Unlimited intake of total fat, saturated fat and
a) The client can breastfeed the baby as long as cholesterol
she continues to maintain a PKU-restricted c. Including adequate servings of fruits, vegetables and
diet. the dairy group
d. Applicable to with either Type 1 or Type 2 diabetes
b) The client should alternate breastfeedings with mellitus
bottle feedings in order to reduce PKU levels
provided to the baby.

c) The client should be advised to not breastfeed The nurse working in the physician's office is reviewing
the infant, because her breast milk will contain lab results on the clients seen that day. One of the
large amounts of phenylalanine clients who has classic diabetic symptoms had an
eight-hour fasting plasma glucose test done. The nurse
d) The client can breasteed for the first three realizes that diagnostic criteria developed by the
months without any untoward effects on the American Diabetes Association for diabetes include
infant. classic diabetic symptoms plus which of the following
fasting plasma glucose levels?
The nurse is teaching a client diagnosed with
phenylketonuria (PKU) about foods to be avoided in a. Greater than 106 mg/dl
the daily diet. Which foods can have an adverse effect b. Greater than 126 mg/dl
on the mother and fetus? Select all that apply.
c. Higher than 140 mg/dl
d. Higher than 160 mg/dl
a) Milk
b) Eggs
c) Nuts
d) Fruits When taking a health history, the nurse screens for
e) Vegetables manifestations suggestive of diabetes type I. Which of
the following manifestations are considered the
The nurse is caring for a diabetic client who is primary manifestations of diabetes type I and would be
pregnant. What does the nurse instruct the client about most suggestive of diabetes type I and require follow-
self-care during illness? Select all that apply. up investigation?
The nurse is educating a pregnant client who has
a. Excessive intake of calories, rapid weight gain, and
gestational diabetes. Which of the following statements
difficulty losing weight
should the nurse make to the client? Select all that
b. Poor circulation, wound healing, and leg ulcers,
apply.
c. Lack of energy, weight gain, and depression
d. An increase in three areas: thirst, intake of
a. Cakes, candies, cookies, and regular soft drinks
fluids, and hunger
should be avoided.
b. Gestational diabetes increases the risk that the
mother will develop diabetes later in life.
c. Gestational diabetes usually resolves after the The nurse is working with an overweight client who has
baby is born. a high-stress job and smokes. This client has just
received a diagnosis of Type II Diabetes and has just Which of the following things must the nurse working with
been started on an oral hypoglycemic agent. Which of diabetic clients keep in mind about Hyperglycemic
the following goals for the client which if met, would be Hyperosmolar Nonketotic Syndrome (HHNS)?
most likely to lead to an improvement in insulin
efficiency to the point the client would no longer require
oral hypoglycemic agents? A. This syndrome occurs mainly in people with Type I
Diabetes
B. It has a higher mortality rate than Diabetic
a. Comply with medication regimen 100% for 6 months
Ketoacidosis
b. Quit the use of any tobacco products by the end of
C. The client with HHNS is in a state of overhydration
three months
D. This condition develops very rapidly
c. Lose a pound a week until weight is in 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 Which one of the following methods/techniques will the
nurse use when giving insulin to a thin person? [Hint]

A. Pinch the skin up and use a 90 degree angle

When working in the community, the nurse will B. Use a 45 degree angle with the skin pinched up
recommend routine screening for diabetes when the C. Massage the area of injection after injecting the insulin
person has one or more of seven risk criteria. Which of D. Warm the skin with a warmed towel or washcloth prior
the following persons that the nurse comes in contact to the injection
with most needs to be screened for diabetes based on
the seven risk criteria?
The nurse is performing discharge teaching for a patient
with Addison's disease. It is MOST important for the nurse
a. A woman who is at 90% of standard body weight to instruct the patient about:
after delivering an eight-pound baby
b. A middle-aged Caucasian male a. signs and symptoms of infection
c. An older client who is hypotensive b. fluid and electrolyte balance
d. A client with an HDL cholesterol level of 40 c. seizure precautions
mg/dl and a triglyceride level of 300 mg/dl d. steroid replacement

Risk factors for type 2 diabetes include all of the following

The nurse assisting in the admission of a client with
except:
diabetic ketoacidosis will anticipate the physician
ordering which of the following types of intravenous a. Advanced age
solution if the client cannot take fluids orally? b. Obesity
c. Smoking
a. 0.45% normal saline solution d. Physical inactivity
b. Lactated Ringer's solution
c. 0.9 normal saline solution
d. 5% dextrose in water (D5W) Prediabetes is associated with all of the following except:

a. Increased risk of developing type 2 diabetes

You are doing some teaching with a client who is starting b. Impaired glucose tolerance
on a sulfonylurea antidiabetic agent. The client mentions c. Increased risk of heart disease and stroke
that he usually has a couple of beers each night and d. Increased risk of developing type 1 diabetes
takes an aspirin each day to prevent heart attack and/or
strokes. Which of the following responses would be best
on the part of the nurse? Blood sugar is well controlled when Hemoglobin A1C is:

a. As long as you only drink two beers and take one a. Below 7%
aspirin, this should not be a problem b. Between 12%-15%
b. The aspirin is alright but you need to give up drinking c. Less than 180 mg/dL
any alcoholic beverages d. Between 90 and 130 mg/dL
c. Aspirin and alcohol will cause the stomach to bleed
more when on a sulfonylurea drug
d. Taking alcohol and/or aspirin with a sulfonylurea
drug can cause development of hypoglycemia
Proliferative retinopathy is often treated using: a. Caucasian woman.
b. Asian woman.
a. Tonometry c. African-American woman.
b. Fluorescein angiogram d. Hispanic male.
c. Antibiotics
d. Laser surgery
Which of the following factors are risks for the
development of diabetes mellitus? (Select all that apply.)
Which of the following diabetes drugs acts by decreasing
the amount of glucose produced by the liver? a. Age over 45 years
b. Overweight with a waist/hip ratio >1
a. Sulfonylureas c. Having a consistent HDL level above 40 mg/dl
b. Meglitinides d. Maintaining a sedentary lifestyle
c. Biguanides
d. Alpha-glucosidase inhibitors
Which laboratory test should a nurse anticipate a
physician would order when an older person is identified
A 37-year-old forklift operator presents with shakiness, as high-risk for diabetes mellitus? (Select all that apply.)
sweating, anxiety, and palpitations and tells the nurse he
has type 1 diabetes mellitus. Which of the follow actions a. Fasting Plasma Glucose (FPG)
should the nurse do first? b. Two-hour Oral Glucose Tolerance Test (OGTT)
c. Glycosylated hemoglobin (HbA1C)
A. Inject 1 mg of glucagon subcutaneously. d. Finger stick glucose three times daily
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. Of which of the following symptoms might an older
woman with diabetes mellitus complain?

a. Anorexia
b. Pain intolerance
c. Weight loss
d. Perineal itching

A thirty five year old male has been an insulin-dependent

diabetic for five years and now is unable to urinate. Which
of the following would you most likely suspect?

A client is brought to the emergency room in an A: Atherosclerosis

unresponsive state, and a diagnosis of hyperglycemic B: Diabetic nephropathy
hyperosmolar nonketotic syndrome is made. The nurse C: Autonomic neuropathy
would immediately prepare to initiate which of the D: Somatic neuropathy
following anticipated physician's orders?

a) endotracheal intubation
b) 100 units of NPH insulin Which of the following is accurate pertaining to physical
c) intravenous infusion of normal saline exercise and type 1 diabetes mellitus?
d) intravenous infusion of sodium bicarbonate
a. Physical exercise can slow the progression of
diabetes mellitus.
b. Strenuous exercise is beneficial when the blood
client newly diagnosed with diabetes mellitus has been glucose is high.
stabilized with daily insulin injections. A nurse prepares a c. Patients who take insulin and engage in strenuous
discharge teaching plan regarding the insulin and plans to physical exercise might experience hyperglycemia.
reinforce which of the following concepts? d. Adjusting insulin regimen allows for safe participation in
all forms of exercise.
a) always keep insulin vials refrigerated
b) ketones in the urine signify a need for less insulin
c) increase the amount of insulin before unusual exercise
d) systematically rotate insulin injections within one One of the benefits of Glargine (Lantus) insulin is its
anatomic site ability to:

a. Release insulin rapidly throughout the day to help

control basal glucose.
Which of the following persons would most likely be b. Release insulin evenly throughout the day and
diagnosed with diabetes mellitus? A 44-year-old: control basal glucose levels.
c. Simplify the dosing and better control blood glucose
levels during the day. A newly diagnosed type 1 diabetic patient likes to run 3
d. Cause hypoglycemia with other manifestation of other miles several mornings a week. Which teaching will the
adverse reactions. nurse implement about exercise for this patient?

a. "You should not take the morning NPH insulin before

A frail elderly patient with a diagnosis of type 2 diabetes you run."
mellitus has been ill with pneumonia. The client's intake b. "Plan to eat breakfast about an hour before your
has been very poor, and she is admitted to the hospital run."
for observation and management as needed. What is the c. "Afternoon running is less likely to cause
most likely problem with this patient? hypoglycemia."
d. "You may want to run a little farther if your glucose is
a. Insulin resistance has developed. very high."
b. Diabetic ketoacidosis is occurring.
c. Hypoglycemia unawareness is developing.
d. Hyperglycemic hyperosmolar non-ketotic coma A patient with type 1 diabetes has received diet
instruction as part of the treatment plan. The nurse
determines a need for additional instruction when the
A patient received 6 units of REGULAR INSULIN 3 hours patient says,
ago. The nurse would be MOST concerned if which of the
following was observed? a. "I may have an occasional alcoholic drink if I include it
in my meal plan."
a. kussmaul respirations and diaphoresis b. "I will need a bedtime snack because I take an evening
b. anorexia and lethargy dose of NPH insulin."
c. diaphoresis and trembling c. "I will eat meals as scheduled, even if I am not hungry,
d. headache and polyuria to prevent hypoglycemia."
d. "I may eat whatever I want, as long as I use enough
insulin to cover the calories."

A patient newly diagnosed with Type I DM is being seen

by the home health nurse. The doctors orders include:
1200 calorie ADA diet, 15 units NPH insulin before Intramuscular glucagon is administered to an
breakfast, and check blood sugar qid. When the nurse unresponsive patient for treatment of hypoglycemia.
visits the patient at 5 pm, the nurse observes the man Which action should the nurse take after the patient
performing blood sugar analysis. The result is 50 mg/dL. regains consciousness?
The nurse would expect the patient to be
a. Give the patient a snack of cheese and crackers.
a. confused with cold, clammy skin an pulse of 110 b. Have the patient drink a glass of orange juice or nonfat
b. lethargic with hot dry dkin and rapid deep respirations milk.
c. alert and cooperative with BP of 130/80 and c. Administer a continuous infusion of 5% dextrose for 24
respirations of 12 hours.
d. short of breath, with distended neck veins and d. Assess the patient for symptoms of hyperglycemia.
bounding pulse of 96.

Which of these laboratory values noted by the nurse

The nurse is having difficulty obtaining a capillary blood when reviewing the chart of a diabetic patient indicates
sample from a client's finger to measure blood glucose the need for further assessment of the patient?
using a blood glucose monitor. Which procedure will
increase the blood flow to the area to ensure an adequate a. Fasting blood glucose of 130 mg/dl
specimen? b. Noon blood glucose of 52 mg/dl
c. Glycosylated hemoglobin of 6.9%
a. Raise the hand on a pillow to increase venous flow. d. Hemoglobin A1C of 5.8%
b. Pierce the skin with the lancet in the middle of the
finger pad.
c. Wrap the finger in a warm cloth for 30-60 seconds. Which of these laboratory values noted by the nurse
d. Pierce the skin at a 45-degree angle. when reviewing the chart of a diabetic patient indicates
the need for further assessment of the patient?

a. Fasting blood glucose of 130 mg/dl

b. Noon blood glucose of 52 mg/dl
c. Glycosylated hemoglobin of 6.9%
d. Hemoglobin A1C of 5.8%
A 63-year-old patient is newly diagnosed with type 2 d. check glucose level before, during, and after
diabetes. When developing an education plan, the nurse's swimming.
first action should be to

a. assess the patient's perception of what it means to A patient with type 1 diabetes who uses glargine (Lantus)
have type 2 diabetes. and lispro (Humalog) insulin develops a sore throat,
b. demonstrate how to check glucose using capillary cough, and fever. When the patient calls the clinic to
blood glucose monitoring. report the symptoms and a blood glucose level of 210
c. ask the patient's family to participate in the diabetes mg/dl, the nurse advises the patient to
education program.
d. discuss the need for the patient to actively participate a. use only the lispro insulin until the symptoms of
in diabetes management. infection are resolved.
b. monitor blood glucose every 4 hours and notify the
clinic if it continues to rise.
c. decrease intake of carbohydrates until glycosylated
hemoglobin is less than 7%.
A patient recovering from DKA asks the nurse how d. limit intake to non-calorie-containing liquids until the
acidosis occurs. The best response by the nurse is that glucose is within the usual range.

a. insufficient insulin leads to cellular starvation, and as

cells rupture they release organic acids into the blood.
Amitriptyline (Elavil) is prescribed for a diabetic patient
b. when an insulin deficit causes hyperglycemia, then with peripheral neuropathy who has burning foot pain
proteins are deaminated by the liver, causing acidic by- occurring mostly at night. Which information should the
products. nurse include when teaching the patient about the new
medication?
c. excess glucose in the blood is metabolized by the liver
into acetone, which is acidic. a. Amitriptyline will help prevent the transmission of
pain impulses to the brain.
d. an insulin deficit promotes metabolism of fat b. Amitriptyline will improve sleep and make you less
stores, which produces large amounts of acidic aware of nighttime pain.
ketones. c. Amitriptyline will decrease the depression caused by
the pain.
d. Amitriptyline will correct some of the blood vessel
changes that cause pain.
A patient using a split mixed-dose insulin regimen asks
the nurse about the use of intensive insulin therapy to
achieve tighter glucose control. The nurse should teach
the patient that A patient who has just been diagnosed with type 2
diabetes is 5 ft 4 in (160 cm) tall and weighs 182 pounds
a. intensive insulin therapy requires three or more (82 kg). A nursing diagnosis of imbalanced nutrition: more
injections a day in addition to an injection of a basal than body requirements is developed. Which patient
long-acting insulin. outcome is most important for this patient?
b. intensive insulin therapy is indicated only for newly
diagnosed type 1 diabetics who have never experienced a. The patient will have a diet and exercise plan that
ketoacidosis. results in weight loss.
c. studies have shown that intensive insulin therapy is b. The patient will state the reasons for eliminating simple
most effective in preventing the macrovascular sugars in the diet.
complications characteristic of type 2 diabetes. c. The patient will have a glycosylated hemoglobin
d. an insulin pump provides the best glucose control and level of less than 7%.
requires about the same amount of attention as intensive d. The patient will choose a diet that distributes calories
insulin therapy. throughout the day.

A college student who has type 1 diabetes normally walks A 1200-calorie diet and exercise are prescribed for a
each evening as part of an exercise regimen. The student patient with newly diagnosed type 2 diabetes. The patient
now plans to take a swimming class every day at 1:00 tells the nurse, "I hate to exercise! Can't I just follow the
PM. The clinic nurse teaches the patient to diet to keep my glucose under control?" The nurse
teaches the patient that the major purpose of exercise for
a. delay eating the noon meal until after the swimming diabetics is to
class.
b. increase the morning dose of neutral protamine a. increase energy and sense of well-being, which will
Hagedorn (NPH) insulin on days of the swimming class. help with body image.
c. time the morning insulin injection so that the peak b. facilitate weight loss, which will decrease
occurs while swimming. peripheral insulin resistance.
c. improve cardiovascular endurance, which is important
for diabetics. Cardiac monitoring is initiated for a patient in diabetic
d. set a successful pattern, which will help in making ketoacidosis (DKA). The nurse recognizes that this
other needed changes. measure is important to identify

a. electrocardiographic (ECG) changes and

The nurse teaches the diabetic patient who rides a dysrhythmias related to hypokalemia.
bicycle to work every day to administer morning insulin b. fluid overload resulting from aggressive fluid
into the replacement.
c. the presence of hypovolemic shock related to osmotic
a. thigh. diuresis.
b. buttock. d. cardiovascular collapse resulting from the effects of
c. arm. hyperglycemia.
d. abdomen

A patient with type 2 diabetes that is controlled with diet

A patient with type 1 diabetes has been using self- and metformin (Glucophage) also has severe rheumatoid
monitoring of blood glucose (SMBG) as part of diabetes arthritis (RA). During an acute exacerbation of the
management. During evaluation of the patient's technique patient's arthritis, the health care provider prescribes
of SMBG, the nurse identifies a need for additional prednisone (Deltasone) to control inflammation. The
teaching when the patient nurse will anticipate that the patient may

a. chooses a puncture site in the center of the finger a. require administration of insulin while taking
pad. prednisone.
b. washes the puncture site using soap and water. b. develop acute hypoglycemia during the RA
c. says the result of 130 mg indicates good blood sugar exacerbation.
control. c. have rashes caused by metformin-prednisone
d. hangs the arm down for a minute before puncturing the interactions.
site. d. need a diet higher in calories while receiving
prednisone.

A diabetic patient is admitted with ketoacidosis and the

health care provider writes all of the following orders. A program of weight loss and exercise is recommended
Which order should the nurse implement first? for a patient with impaired fasting glucose (IFG). When
teaching the patient about the reason for these lifestyle
a. Start an infusion of regular insulin at 50 U/hr. changes, the nurse will tell the patient that
b. Give sodium bicarbonate 50 mEq IV push.
c. Infuse 1 liter of normal saline per hour. a. the high insulin levels associated with this syndrome
d. Administer regular IV insulin 30 U. damage the lining of blood vessels, leading to vascular
disease.
b. although the fasting plasma glucose levels do not
currently indicate diabetes, the glycosylated hemoglobin
will be elevated.
c. the liver is producing excessive glucose, which will
A diabetic patient is started on intensive insulin therapy.
eventually exhaust the ability of the pancreas to produce
The nurse will plan to teach the patient about mealtime
insulin, and exercise will normalize glucose production.
coverage using _____ insulin.
d. the onset of diabetes and the associated
cardiovascular risks can be delayed or prevented by
a. NPH
weight loss and exercise.
b. lispro
c. detemir
d. glargine
A patient screened for diabetes at a clinic has a fasting
plasma glucose level of 120 mg/dl (6.7 mmol/L). The
nurse will plan to teach the patient about
A patient with type 2 diabetes is scheduled for an
outpatient coronary arteriogram. Which information
a. use of low doses of regular insulin.
obtained by the nurse when admitting the patient
b. self-monitoring of blood glucose.
indicates a need for a change in the patient's regimen?
c. oral hypoglycemic medications.
d. maintenance of a healthy weight.
a. The patient's most recent hemoglobin A1C was 6%.
b. The patient takes metformin (Glucophage) every
morning.
c. The patient uses captopril (Capoten) for hypertension. A hospitalized diabetic patient receives 12 U of regular
d. The patient's admission blood glucose is 128 mg/dl. insulin mixed with 34 U of NPH insulin at 7:00 AM. The
patient is away from the nursing unit for diagnostic testing
at noon, when lunch trays are distributed. The most
appropriate action by the nurse is to
a. The patient disposes of the open insulin vials after
a. save the lunch tray to be provided upon the patient's 4 weeks.
return to the unit. b. The patient draws up the regular insulin in the syringe
b. call the diagnostic testing area and ask that a 5% and then draws up the glargine.
dextrose IV be started.
c. ensure that the patient drinks a glass of milk or orange
juice at noon in the diagnostic testing area. c. The patient stores extra vials of both types of insulin in
d. request that the patient be returned to the unit to the freezer until needed.
eat lunch if testing will not be completed promptly. d. The patient's family prefills the syringes weekly and
stores them in the refrigerator.

When assessing the patient experiencing the onset of

symptoms of type 1 diabetes, which question should the A type 1 diabetic patient who was admitted with severe
nurse ask? hypoglycemia and treated tells the nurse, "I did not have
any of the usual symptoms of hypoglycemia." Which
a. "Have you lost any weight lately?" question by the nurse will help identify a possible reason
b. "Do you crave fluids containing sugar?" for the patient's hypoglycemic unawareness?
c. "How long have you felt anorexic?"
d. "Is your urine unusually dark-colored?" a. "Do you use any calcium-channel blocking drugs for
blood pressure?"
b. "Have you observed any recent skin changes?"
c. "Do you notice any bloating feeling after eating?"
While hospitalized and recovering from an episode of
d. "Have you noticed any painful new ulcerations or sores
diabetic ketoacidosis, the patient calls the nurse and
on your feet?"
reports feeling anxious, nervous, and sweaty. Based on
the patient's report, the nurse should

a. obtain a glucose reading using a finger stick. A health care provider who has not been immunized for
b. administer 1 mg glucagon subcutaneously. hepatitis B is exposed to the hepatitis B virus (HBV)
c. have the patient eat a candy bar. through a needle stick from an infected patient. The
d. have the patient drink 4 ounces of orange juice. infection control nurse informs the individual that
treatment for the exposure should include

a. baseline hepatitis B antibody testing now and in 2

A patient with type 2 diabetes has sensory neuropathy of
months.
the feet and legs and peripheral vascular disease
b. active immunization with hepatitis B vaccine.
evidenced by decreased peripheral pulses and
c. hepatitis B immune globulin (HBIG) injection.
dependent rubor. The nurse teaches the patient that
d. both the hepatitis B vaccine and HBIG injection.
a. the feet should be soaked in warm water on a daily
basis.
b. flat-soled leather shoes are the best choice to A client has recently been diagnosed with Type I diabetes
protect the feet from injury. and asks the nurse for help formulating a nutrition plan.
c. heating pads should always be set at a very low Which of the following recommendations would the nurse
temperature. make to help the client increase calorie consumption to
d. over-the-counter (OTC) callus remover may be used to offset absorption problems?
remove callus and prevent pressure.
a. Eating small meals with two or three snacks may
be more helpful in maintaining blood glucose levels
than three large meals.
A diagnosis of hyperglycemic hyperosmolar nonketotic
coma (HHNC) is made for a patient with type 2 diabetes
b. Eat small meals with two or three snacks throughout
who is brought to the emergency department in an
the day to keep blood glucose levels steady
unresponsive state. The nurse will anticipate the need to
c. Increase consumption of simple carbohydrates
a. administer glargine (Lantus) insulin.
b. initiate oxygen by nasal cannula.
d. Skip meals to help lose weight
c. insert a large-bore IV catheter.
d. give 50% dextrose as a bolus.

When a client learned that the symptoms of diabetes

were caused by high levels of blood glucose the client
After the home health nurse has taught a patient and
decided to stop eating carbohydrates. In this instance, the
family about how to use glargine and regular insulin
nurse would be concerned that the client would develop
safely, which action by the patient indicates that the
what complication?
teaching has been successful?
 B. The client should alternate breastfeeding with
a. acidosis bottle feedings in order to reduce PKU levels
b. atherosclerosis provided to the baby.
c. glycosuria C. The client should be advised to not
d. retinopathy breastfeed the infant, because her breast
milk will contain large amounts of
phenylalanine
When a client learned that the symptoms of diabetes D. The client can breastfeed for the first three
were caused by high levels of blood glucose the client months without any untoward effects on the
decided to stop eating carbohydrates. In this instance, the infant.
nurse would be concerned that the client would develop
what complication? 3. The nurse is teaching a client diagnosed with
phenylketonuria (PKU) about foods to be avoided in
a. acidosis the daily diet. Which foods can have an adverse effect
b. atherosclerosis
on the mother and fetus? Select all that apply.
c. glycosuria
A. Milk
d. retinopathy
B. Eggs
C. Nuts
D. Fruits
E. Vegetables
The doctor is interested in how well a client has controlled
their blood glucose since their last visit. What lab values 4. The nurse is caring for a diabetic client who is
could the nurse evaluate to determine how well the client pregnant. What does the nurse instruct the client about
has controlled their blood glucose over the past three self-care during illness? Select all that apply.
months?  Drink as much fluid as possible
 Obtain as much rest as possible
Answer: C  Check your blood glucose levels at regular
intervals

During a teaching session, the nurse tells the client that 5. What are the complications associated with
50% to 60% of daily calories should come from polyhydramnios? Select all that apply.
carbohydrates. What should the nurse say about the A. Ketoacidosis
types of carbohydrates that can be eaten? B. Placental abruption
C. Uterine dysfunction
a. Simple carbohydrates are absorbed more rapidly than
D. Gestational diabetes
complex carbohydrates.
E. Postpartum hemorrhage
b. Simple sugars cause a rapid spike in glucose levels
and should be avoided 6. Which manifestation does the nurse relate to
hypoglycemia in a diabetic client?
c. Simple sugars should never be consumed by someone A. Clammy skin
with diabetes. B. Rapid breathing
C. Nausea or vomiting
d. Try to limit simple sugars to between 10% and 20% D. Increased urination
of daily calories. 7. The nurse is using White's classification of diabetes
in pregnancy. What are the features of White's
1. When a pregnant woman with diabetes experiences classification? Select all that apply.
hypoglycemia while hospitalized, what should the A. It considers the duration of diabetes in the
nurse have the woman do? client.
A. Eat a candy bar B. It is based on the age at which diabetes
B. Eat 5 or 6 hard candies or drink 8 oz of milk was diagnosed.
C. Drink 4 oz of orange juice followed by 8 oz of C. It is based on the involvement of the eye
milk. and the kidneys.
D. Drink 8 oz of orange juice with 2 teaspoons of D. It classified as type 1, type 2, others, and
sugar added. gestational diabetes.
E. It considers two groups with and without
2. A pregnant woman has maternal phenylketonuria vascular complications
(PKU) and is interested in whether or not she will be
able to breastfeed her baby. Which statement made by 8. The nurse is assessing a client with hyperemesis
the nurse indicates accurate information? gravidarum during the early stages of pregnancy.
A. The client can breastfeed the baby as long as Which nonpharmacologic measure is appropriate to
she continues to maintain a PKU-restricted alleviate the discomforts associated with nausea and
diet. vomiting?
 A. Having the client cook her favorite foods B. The most important cause of perinatal loss
B. Allowing frequent visits from friends in diabetic pregnancy is congenital
C. Providing environment that is free from malformations.
odors C. Infants of mothers with diabetes have the
D. Having the client eat warm, low-fat, soupy same risks for respiratory distress syndrome
foods because of the careful monitoring.
D. At birth, the neonate of a diabetic mother is no
9. Which client may need a cesarean delivery because longer at any greater risk.
of complications related to gestational diabetes?
A. A client with a big fetus 15. Which factor is known to increase the risk of
B. A client with uterine growth gestational diabetes mellitus?
C. A client with reduced fetal movement A. Previous birth of large infant
D. A client with less than normal pelvic brim B. Maternal age younger than 25
C. Underweight before pregnancy
10. The nurse is caring for a client with poorly D. Previous diagnosis of type 2 diabetes mellitus
controlled gestational diabetes. What risks to the fetus
does the nurse anticipate during the later pregnancy 16. The nurse is caring for a client with gestational
stages and birthing process? Select all that apply. diabetes. What does the nurse teach the client about
A. Ketoacidosis using insulin?
B. Macrosomia A. Store unused vials of insulin in the freezer.
C. Shoulder dystocia B. Shake the prepared syringes well before use.
D. Facial nerve injury C. Administer long-acting insulin before meals.
E. Hyperglycemia D. Inject insulin in the abdomen.

11. The blood glucose level of a pregnant client is 325 17. A pregnant woman at 14 weeks of gestation is
mg/dl. Which test should be performed on the patient admitted to the hospital with a diagnosis of
to assess the risk of maternal or intrauterine fetal hyperemesis gravidarum. What is the primary goal of
death? her treatment at this time?
A. Ketones in urine A. Rest the gastrointestinal (GI) tract by
B. Glucose in urine restricting all oral intake for 48 hours
C. Arterial blood gases B. Reduce emotional distress by encouraging
D. Abdominal ultrasound the woman to discuss her feelings
C. Reverse fluid, electrolyte, and acid-base
12. A pregnant woman has contacted the nurse about imbalances
severe nausea and vomiting. What is the priority D. Restore the woman's ability to take and retain
assessment in evaluating a pregnant woman with oral fluid and foods
severe nausea and vomiting?
A. Fasting blood glucose level 18. Which assessment finding does the nurse
B. Ketonuria recognize as an indicator for early screening for
C. Bilirubin gestational diabetes mellitus (GDM)?
D. White Blood cell count A. The client is 24 years old.
B. The client's body mass index (BMI) is 22.
C. The client does not have diabetes.
D. The client had a previous stillbirth.

13. Which patients with diabetes may develop

complications if they perform exercises? Select all that
apply. 19. The insulin dose of a client in the second trimester
A. A client who is on insulin of pregnancy has been increased. When does the
B. A client with diabetic ketoacidosis nurse expect the client's prepregnant dose of insulin to
C. A client with uncontrolled hypertension be recommended again?
D. A client with severe peripheral neuropathy A. When the client starts lactating
E. A client who has lost 5 kg weight after B. When the client delivers the baby
diagnosis C. When the client is in the third trimester
D. When the client weans the baby from
14. Diabetes in pregnancy puts the fetus at risk in breastfeeding
several ways. What should nurses be aware of?
A. With good control of maternal glucose levels, 20. A pregnant client experiences thyroid storm
sudden and unexplained stillbirth is no longer following delivery of the infant. What interventions
a major concern. would the nurse anticipate to be ordered by the
physician? Select all that apply.
 A. Restriction of intravenous fluids to prevent fluid 25. Nurse is caring for a pregnant client with
overload gestational diabetes. What does the nurse teach the
B. Administration of oxygen client about diet during pregnancy?
C. Antipyretics A. Eat three meals a day with two or three
D. Synthroid snacks.
E. PTU B. Avoid meals or snacks just before bedtime.
C. Use artificial sweeteners instead of sugar.
21. A pregnant woman at 28 weeks of gestation has D. Avoid foods that are high in dietary fiber.
been diagnosed with gestational diabetes. Of what
should the nurse be aware regarding this? 26. The nurse is caring for a pregnant client prescribed
A. Oral hypoglycemic agents can be used if the levothyroxine for hypothyroidism. The client is also
woman is reluctant to give herself insulin prescribed an iron supplement. What information does
B. Dietary modifications and insulin are both the nurse provide the client about taking these
required for adequate treatment medications?
C. Glucose levels are monitored by testing urine A. Take both medications together in the morning.
four times a day and at bedtime B. Take levothyroxine 1 hour after taking the iron
D. Dietary management involves distributing supplement.
nutrient requirements over three meals and C. Take the iron supplement 2 hours after taking
two or three snacks levothyroxine.
D. Take the two medications at different times
22. A client who is pregnant already has type 2 of the day.
diabetes and a hemoglobin A1c of 7. What does the
nurse would categorize this client as having? 27. The nurse is teaching a woman with gestational
A. Gestational diabetes diabetes the technique to inject insulin. What should
B. Insulin-dependent diabetes complicated by the nurse include in the teaching session? Select all
pregnancy. that apply.
C. Pregestational diabetes mellitus A. Aspirate before injecting.
D. Non-insulin-dependent diabetes with B. Clean injection site with alcohol.
complications C. Insert the needle at a 90-degree angle.
D. Inject insulin slowly.
23. A pregnant woman with type 1 diabetes is on rapid- E. After injection, cover site with sterile
acting, short-acting, and intermediate-acting insulin gauze.
injections. Which are rapid and short-acting insulins?
Select all that apply. 28. Which obstetric or medical complications should
A. NPH (Novolin N) the nurse be alert for when providing care to a
B. Regular (Humalin) pregnant client with diabetes mellitus? Select all that
C. Lispro (Humalog) apply.
D. Aspart (NovoLog) A. Preeclampsia
E. Glargine (Lantus) B. Hypoglycemia
C. Hydramnios
D. Monilial vaginitis
E. Brachial plexus palsy

29. Which of the following findings is not likely to be

seen in a pregnant client who has hypothyroidism?
A. Miscarriage
B. Macrosomia
24. The nurse is advising a pregnant client who has C. Gestational hypertension
been prescribed lispro (Humalog). What information D. Placental abruption
does the nurse provide about the insulin? Select all 30. Hypothyroidism occurs in 2 to 3 pregnancies per
that apply. 1000. Pregnant women with untreated hypothyroidism
A. It is rapid-acting insulin preferred for use are at risk for what? Select all that apply.
during pregnancy. A. Miscarriage
B. It is injected just before meals and causes B. Macrosomia
less hyperglycemia. C. Gestational hypertension
C. It has shorter duration of action as D. Placental abruption
compared to regular insulin. E. Stillbirth
D. It is released slowly in small amounts with no
pronounced peak. 31. What is gestational diabetes?
E. Its action lasts for 12 hours maintaining A. Diabetes that accompanies hypertension
optimal blood glucose levels. B. Diabetes that begins abruptly at a young age
C. Diabetes caused by absolute insulin deficiency
 D. Diabetes that is diagnosed during A. Loss of electrolytes
pregnancy B. Metabolic alkalosis
C. Cellular dehydration
32. After assessing a client with pregestational D. Increase in the blood volume
diabetes, the nurse suspects that the client belongs to
class R of pregestational diabetes. What is done to 38. The nurse is caring for a pregnant client with type 2
confirm the condition? diabetes. What does the nurse teach the client about
A. The client is referred for a urine sugar test. glucose metabolism in the first trimester?
B. The client is referred for a renal function test. A. Maternal glucose levels are affected by
C. The client is referred for a dilated eye nausea and cravings.
examination. B. The client's insulin dose may need to be
D. The nurse asks the age at which the client increased to prevent hyperglycemia.
acquired diabetes. C. The fetus will produce insulin in the fifth week
of gestation.
33. For what condition is a client at risk in early D. The client's fasting blood glucose level will
pregnancy due to poorly controlled hyperglycemia? increase.
A. Miscarriage
B. Hydramnios 39. The nurse finds that the blood pH of a pregnant
C. Preeclampsia client who is diabetic is 6.5. What should the nurse
D. Ketoacidosis administer to normalize the client's blood pH?
A. Dextrose solution
34. The nurse is assessing a client for gestational B. Normal saline solution
diabetes mellitus (GDM) using the oral glucose C. Sodium citrate solution
tolerance test (OGTT). What intervention by the nurse D. Sodium bicarbonate solution
is appropriate while caring for this client?
A. Teach the client to eat an unrestricted diet the 40. In planning for the care of a 30-year-old woman
day before the test. with pregestational diabetes, the nurse recognizes
B. Instruct the client to avoid caffeine for 6 hours what as the most important factor affecting pregnancy
before the test. outcome?
C. Draw blood for a fasting blood glucose A. Mother's age
level just before the test. B. Number of years since diabetes was
D. Obtain the plasma glucose level an hour after diagnosed
a 50 g oral glucose load. C. Amount of insulin required prenatally
D. Degree of glycemic control during
35. The nurse is caring for a client in the first trimester pregnancy
of pregnancy who is prescribed propylthiouracil (PTU)
for hyperthyroidism. What are the side effects of this 41. In which pregnant client does the nurse identify the
medication? need to screen for undiagnosed homozygous maternal
A. Facial anomalies phenylketonuria (PKU)?
B. Hepatic toxicity A. A client who had a macrosomic fetus in a
C. Esophageal atresia previous pregnancy
D. Developmental delay B. A client who had obstructed labor in a previous
pregnancy
C. A client who has given birth to a
microcephalic infant
D. A patient who had placental insufficiency in a
previous pregnancy

36. After reviewing the blood glucose levels of a client,

the nurse finds that the client is hypoglycemic and
gives three glucose tablets to the client. After 15 42. What does the nurse instruct a pregnant client who
minutes, the nurse finds that the client is still is diabetic to do? Select all that apply.
hypoglycemic, and again administers three glucose A. "Perform exercises just before meals."
tablets. What should the nurse do next, if the client's B. "Perform exercises with a partner."
blood glucose is 60 mg/dl after 15 minutes? C. "Stop exercising if contractions occur."
A. Notify the primary health care provider. D. "Lie supine if contractions occur."
B. Administer 50% dextrose intravenous push. E. "Exercise at the same time every day."
C. Obtain blood samples for blood gas analysis.
D. Give three more glucose tablets to the client. 43. The nurse is assessing a client at 30 weeks of
pregnancy with poorly controlled pregestational
37. What is the pathologic change associated with diabetes. The client has come for the antenatal visit on
diabetic ketoacidosis?
a Monday. When should the nurse ask the client to 49. The nurse is caring for a client in early pregnancy
come next? with hyperemesis. What changes in diet will benefit this
A. Next week on a Monday client?
B. Next week on a Thursday A. Avoiding dairy products and cold foods
C. Same week on a Thursday B. Eating a high-protein snack at bedtime
D. Week after next week on a Monday C. Eating foods that are served warm
D. Avoiding dry, bland, and low-fat foods
44. The nurse is caring for a diabetic client who is
breastfeeding her infant. Within what time frame 50. What are the manifestations associated with
following childbirth do the client's insulin requirements hypoglycemia? Select all that apply.
return to pre-pregnancy levels? A. Dizziness
A. Immediately after childbirth B. Fruity breath
B. Seven to 10 days after childbirth C. Blurred vision
C. On completion of weaning D. Excessive hunger
D. During the lactation period E. Presence of acetone in urine

45. A cesarean birth is planned for a diabetic client with 51. The nurse is teaching a client insulin self-
fetal macrosomia. Which intervention by the nurse is administration technique. What does the nurse include
appropriate when preparing the client for surgery? in the lesson? Select all that apply.
A. Instruct the client to avoid insulin the night  Allow the alcohol to dry before injecting the
before the surgery. insulin
B. Administer a full dose of insulin on the morning  Apply gentle pressure after the injection.
of the surgery.  Record the dose and time of the injection
C. Ensure the client has nothing by mouth on
the morning of the surgery. 52. What are the potentially fatal complications
D. Infuse intravenous 5% dextrose if the client's associated with diabetes? Select all that apply.
glucose level is below 100 mg/dl. A. Neuropathy
B. Nephropathy
46. What are the metabolic changes associated with C. Atherosclerosis
pregnancy? Select all that apply. D. Cardiomyopathy
A. Maternal production of insulin increases E. Restrictive lung disease
during the first trimester.
B. Fasting blood glucose levels will decrease 53. For which condition should the nurse be alert after
during the first trimester. administering terbutaline (Brethine) to a pregnant client
C. The patient's tolerance to glucose increases in with diabetes mellitus?
the second trimester. A. Dyspnea
D. There is enough glucose for the fetus B. Infection
during the second trimester. C. Ketoacidosis
E. Maternal insulin requirements increase during D. Hypoglycemia
the first trimester.

47. A pregnant client with pregestational insulin-

dependent diabetes is going for a week's vacation to
another state. What should the nurse ask the client to
carry with her in order to prevent complications? Select
all that apply.
 Insulin vials
 Glucose tablets
 Blood glucose meter

48. What are maternal and neonatal risks associated

with gestational diabetes mellitus?
A. Maternal premature rupture of membranes and
neonatal sepsis.
B. Maternal hyperemesis and neonatal low birth
weight.
Correct
C. Maternal preeclampsia and fetal
macrosomia.
D. Maternal placenta previa and fetal prematurity.