Welcome future nurses! As you gear up to conquer the NCLEX, understanding how to answer NCLEX questions on Type 2 Diabetes is paramount to ensuring your success. Let’s dive in.
Question 1: A 55-year-old patient with a history of type 2 diabetes arrives at the clinic complaining of increased thirst, frequent urination, and fatigue. On examination, the nurse notes dry mucous membranes and deep, rapid breathing. Blood glucose levels are markedly elevated. What complication of diabetes is the patient likely experiencing?
a) Diabetic ketoacidosis (DKA)
b) Hyperosmolar hyperglycemic state (HHS)
c) Hypoglycemia
d) Hyperglycemic hyperosmolar syndrome (HHS)
e) Insulin resistance syndrome
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Rationale: The vignette describes symptoms associated with diabetic ketoacidosis (DKA), such as polyuria, polydipsia, dehydration (dry mucous membranes), Kussmaul breathing (deep, rapid breathing), and markedly elevated blood glucose levels. DKA is a life-threatening complication of uncontrolled diabetes characterized by ketone production and metabolic acidosis.
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Question 2: A 65-year-old patient with type 2 diabetes mellitus presents to the emergency department with confusion, weakness, and diaphoresis. The patient’s blood glucose level is 50 mg/dL. Which of the following is the most appropriate initial intervention for this patient?
a) Administer IV insulin
b) Administer IV dextrose
c) Administer oral glucose
d) Administer glucagon injection
e) Administer a highcarbohydrate meal
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Rationale: The patient is experiencing hypoglycemia, indicated by the low blood glucose level and neuroglycopenic symptoms. In this situation, the appropriate initial intervention is the administration of glucagon, which helps increase blood glucose levels by promoting glycogenolysis in the liver, raising blood sugar rapidly in an unconscious or unable to swallow patient.
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Question 3: A 45-year-old patient with type 2 diabetes visits the clinic for a followup appointment. The patient reports adhering to the prescribed diet, exercise regimen, and oral antidiabetic medications but has noticed an increase in fasting blood glucose levels. On further inquiry, the patient admits to occasionally skipping meals due to work commitments. What phenomenon could be contributing to the elevated fasting blood glucose levels in this patient?
a) Dawn phenomenon
b) Somogyi effect
c) Insulin resistance
d) Reactive hypoglycemia
e) Beta-cell dysfunction
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Rationale: The patient’s elevated fasting blood glucose levels despite adherence to treatment suggest the dawn phenomenon, characterized by increased glucose production in the early morning due to hormonal changes, leading to elevated fasting blood sugar levels. Skipping meals, especially dinner, can exacerbate this effect by altering insulin levels overnight.
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Understanding Type 2 Diabetes: Causes and Symptoms
Question 4: A 40-year-old patient with type 2 diabetes presents with complaints of tingling sensations in their feet and hands. On assessment, the nurse finds decreased vibration sense and absent ankle reflexes. Which condition is most likely causing these symptoms?
a) Hypoglycemia
b) Diabetic neuropathy
c) Hyperthyroidism
d) Peripheral arterial disease
e) Multiple sclerosis
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Rationale: The symptoms of tingling, decreased vibration sense, and absent ankle reflexes are classic manifestations of diabetic neuropathy, a common long-term complication of diabetes resulting from nerve damage due to prolonged hyperglycemia.
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Question 5: A 55-year-old patient with type 2 diabetes visits the clinic complaining of visual disturbances. On examination, the nurse notes retinal hemorrhages, microaneurysms, and cotton-wool spots. What condition is the patient most likely experiencing?
a) Diabetic retinopathy
b) Cataracts
c) Glaucoma
d) Macular degeneration
e) Retinal detachment
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Rationale: The described symptoms, including retinal hemorrhages, microaneurysms, and cotton-wool spots, are indicative of diabetic retinopathy, a common complication of diabetes characterized by damage to blood vessels in the retina, leading to vision impairment or loss if left untreated.
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Question 6: A 60-year-old patient with type 2 diabetes is prescribed metformin. The nurse educates the patient about the medication and advises to report any signs of lactic acidosis immediately. Which symptom should the patient be instructed to report?
a) Diarrhea
b) Polyuria
c) Hypertension
d) Muscle cramps
e) Rapid heartbeat
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Rationale: Metformin, a commonly used medication for type 2 diabetes, can rarely lead to lactic acidosis, especially in individuals with renal impairment. Diarrhea can be an early sign of this serious adverse effect and should be reported promptly to prevent complications.
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Question 7: A 50-year-old patient with type 2 diabetes seeks advice on preventing diabetic foot ulcers. Which instruction should the nurse prioritize in the patient’s education?
a) Keep feet moisturized with lotion
b) Wear well-fitting shoes
c) Soak feet in warm water daily
d) Use heating pads for cold feet
e) Walk barefoot indoors
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Rationale: Properly fitted shoes help prevent pressure points and reduce the risk of foot injuries and ulcers in diabetic patients. Moisturizing feet, avoiding prolonged exposure to warm water, refraining from heating pads, and avoiding walking barefoot are also crucial components of foot care for individuals with diabetes, but proper footwear is a priority to prevent complications.
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Question 8: A 65-year-old patient with type 2 diabetes is admitted with a foot wound. On assessment, the nurse observes redness, warmth, and swelling around the wound site, with purulent discharge. The patient reports fever and chills. Which complication of diabetes is the patient most likely experiencing?
a) Diabetic ketoacidosis (DKA)
b) Hyperglycemic hyperosmolar state (HHS)
c) Diabetic nephropathy
d) Diabetic foot ulcer
e) Diabetic neuropathy
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Rationale: The described symptoms—redness, warmth, swelling, purulent discharge, fever, and chills—are indicative of an infected diabetic foot ulcer, a common complication of diabetes due to impaired wound healing and peripheral neuropathy.
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Question 9: A 50-year-old patient with type 2 diabetes seeks advice on managing high blood glucose levels after meals. Which action should the nurse recommend to help control postprandial hyperglycemia?
a) Increase carbohydrate intake
b) Perform highintensity exercise before meals c) Take rapid-acting insulin immediately after meals
d) Consume a balanced meal with fiber and protein
e) Skip meals to lower overall glucose intake
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Rationale: Consuming a balanced meal that includes fiber and protein helps slow the absorption of glucose, reducing postprandial hyperglycemia. It promotes more stable blood sugar levels after eating compared to high-carbohydrate meals, and it is a sustainable approach to managing glucose levels without causing hypoglycemia.
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Question 10: A 55-year-old patient with type 2 diabetes is prescribed a sulfonylurea medication. The nurse provides education about potential side effects. Which adverse effect is commonly associated with sulfonylureas?
a) Weight loss
b) Hypoglycemia
c) Hyperglycemia
d) Hypertension
e) Increased insulin resistance
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Rationale: Sulfonylureas stimulate insulin secretion and can lead to hypoglycemia, especially if the medication dose is too high or if meals are missed. Patients should be educated on the signs and symptoms of hypoglycemia and how to manage it to prevent complications.