Diabetes Mellitus (36 Questions)

1.1 Mr. Pascal Gendron, a 66-year-old patient, has been hospitalized for uncontrolled type II diabetes. During your morning rounds, he tells you:
"Ever since the beginning of summer, my blood sugar has been high no matter what I do."

You check his capillary blood glucose, which reads 9 mmol/L.

Question:
What clinical data would you prioritize obtaining to better evaluate Mr. Gendron’? *

Glycated hemoglobin (HbA1c)

Ketonuria

Presence of tremors

Glycosuria

1.2 Later in the day, Mr. Pascal Gendron, who also underwent a diagnostic bronchoscopy earlier that morning, is transferred back to your unit from recovery.
One hour post-procedure, you assess the patient and note the following:
He appears slightly dyspneic and is using accessory muscles to breathe.
He reports a dry, persistent cough and mild chest pain on the affected side.
You auscultate his lungs and note decreased breath sounds on the right side.
SpO₂ is 91% on room air.

His respiratory rate is 24 breaths per minute.

Question:
Based on the post-bronchoscopy findings, what do you suspect is the most likely complication? *

Bronchospasm

Pneumothorax

Atelectasis

Pneumonia

2.1 Ms. Gascon, 48 years old, was admitted for cellulitis in her left forearm. Her medical record indicates a past history of type 2 diabetes, hypertension and dyslipidemia. Her BMI is 25 kg/m2 and she is not a smoker.

Since she was admitted, Ms. Gascon has been having episodes of hyperglycemia when she wakes up in the morning. The physician changed the medical orders yesterday:

*Humulin® R insulin at meals and 1/2 dose at bedtime, as per scale.
*Humulin® N insulin 16 units at breakfast and Humulin® N insulin 12 units at supper.

Ms. Gascon eats a piece of cheese and two crackers at 21:00.

The next day, at 05:00, you observe that Ms. Gascon is trembling and that her skin is clammy. She tells you that she is having palpitations. You check her blood glucose with a glucometer: 3.0 mmol/L. Ms. Gascon drinks 175 ml of orange juice.

Fifteen minutes later, Ms. Gascon’s blood glucose is 3.6 mmol/L. She says to you: “Can you get me a cracker with peanut butter? That’s what I take to get my blood sugar level back to normal when I’m at home.”

Question:
Will you agree to do as she asks? *

Yes, because the carbohydrates raised her blood glucose and relieved her symptoms.

Yes, because eating protein will prolong the effect of the carbohydrates.

No, because this type of snack would slow down the absorption of carbohydrates.

No, because her blood glucose is still below 4.0 mmol/L.

2.2 Ms. Gascon’s clinical condition has stabilized and you are talking with a nursing intern who is paired with you. She is wondering why Ms. Gascon had an episode of hypoglycemia this morning.

Question:
What is the most likely cause of her hypoglycemia? *

The Humulin® R insulin she was given at supper.

The Humulin® R insulin she was given at bedtime.

The Humulin® N insulin she was given at breakfast.

The Humulin® N insulin she was given at supper.

3.1 Gabrielle, a 19-year-old college student, was recently diagnosed with type 1 diabetes mellitus. While attending class, she develops a headache, reports blurred vision, and feels anxious and shaky. She realizes she forgot her portable blood glucose monitor in her dorm room.

She seeks help from the campus health nurse, unsure of what to do.

Question:
What should the campus nurse advise Gabrielle to do? *

Eat a piece of pizza.

Drink some diet pop.

Eat 15 g of simple carbohydrates.

Take an extra dose of rapid-acting insulin.

4. M. Maxime Tremblay, a 19-year-old male with Type 1 Diabetes, is brought to the Emergency Department by his roommate. The roommate states M. Tremblay went for a long run, returned home, and started acting "bizarre and aggressive." On assessment, M. Tremblay is confused, his skin is pale and cool, and he is diaphoretic. His vital signs are: BP 110/70 mmHg, HR 112 bpm, RR 18 breaths/min.

The nurse performs a capillary blood glucose (CBG) test, which reads 2.1 mmol/L. M. Tremblay is conscious but disoriented and struggling against the nurse.

Question:
What is the nurse’s priority intervention? *

Administer 1 mg of Glucagon IM immediately.

Force the patient to drink 175 mL of orange juice.

Start an IV and administer 50 mL of D50W (Dextrose 50%).

Recheck the blood glucose in 15 minutes to confirm the result.

5. Mme Sophie Gagnon, 45 years old, is admitted with Diabetic Ketoacidosis (DKA). She is drowsy and has Kussmaul respirations.

Her admission labs are:
*Glucose: 28.0 mmol/L (4 to 7 mmol/L)
*pH: 7.15
*Potassium (K+): 3.1 mmol/L (3.5 to 5.0 mmol/L)
*Ketones: Positive

The physician’s standing orders for DKA include:
*Start IV Normal Saline at 500 mL/hr.
*Start IV Regular Insulin infusion at 0.1 units/kg/hr.
*Monitor cardiac rhythm.

Question:
Based on the laboratory values, what is the nurse’s priority action regarding the medication orders? *

Start the insulin infusion immediately to lower the blood sugar.

Hold the insulin and contact the physician to report the potassium level.

Increase the IV fluid rate to flush out the ketones.

Administer Sodium Bicarbonate to correct the pH.

6. M. Jacques Bernier, 68 years old, has Type 2 Diabetes managed with Metformin (Glucophage). He is admitted for a scheduled cardiac catheterization (angiogram) requiring IV contrast dye.

The medical orders are:
*NPO from midnight.
*Hold Metformin for 48 hours post-procedure.
*IV Normal Saline at 100 mL/hr.

M. Bernier asks the nurse, "Why do I have to stop my sugar pill after the test? My sugar might go up."

Question:
What is the nurse’s best response? *

"The dye can affect your kidneys, and taking Metformin while your kidneys are stressed can cause a dangerous acid buildup."

"The dye reacts with the medication and can cause immediate liver failure."

"Metformin blocks the dye from showing the blockages in your heart."

"It is just to prevent hypoglycemia while you are recovering from sedation."

7. Mme Ginette Roy, 72 years old, presents with Hyperosmolar Hyperglycemic State (HHS). She has a history of Type 2 Diabetes. She lives alone and was found lethargic by her daughter.

Her assessment reveals:
*Dry mucous membranes.
*Poor skin turgor.
*BP 88/50 mmHg, HR 120 bpm.
*Glucose: 42 mmol/L.
*Negative ketones in urine.

Question:
What does the nurse identify as the primary physiological problem that must be addressed first? *

Metabolic Acidosis.

Hyperkalemia.

Severe Dehydration.

Respiratory failure.

8. M. Pierre Dubois, 30 years old, has Type 1 Diabetes. He calls the telehealth nurse because he has the flu (influenza) with nausea and vomiting. He has not eaten solid food for 24 hours. He asks, "Since I'm not eating, should I skip my insulin shots today?"

Question:
What is the nurse’s best instruction (Sick Day Rules)? *

"Yes, do not take any insulin until you can eat a full meal to avoid low blood sugar."

"Take only your long-acting insulin, but skip the mealtime insulin completely."

"Continue taking your insulin, check your blood sugar every 4 hours, and try to drink sugary liquids."

"Stop the insulin and take extra Metformin pills instead."

9. Mme Claudette Lefebvre, 55 years old, attends the diabetes clinic. She has been injecting insulin into her upper thighs for 2 years. During the physical assessment, the nurse palpates a hard, lumpy area on the right anterior thigh. Mme Lefebvre says, "I always inject there because it doesn't hurt anymore."

Question:
What is the nurse’s priority education point regarding this finding? *

"This is a sign of infection; you need antibiotics."

"You should massage the area vigorously after every injection to soften it."

"This is lipodystrophy; injecting here prevents the insulin from absorbing properly, leading to erratic blood sugar."

"This is normal scar tissue; you can continue using this site safely."

10. M. Luc Morin, 60 years old, is newly diagnosed with Type 2 Diabetes. The physician prescribes:
*Glyburide (Diabeta) 5 mg PO daily with breakfast.

The nurse provides medication teaching.

Question:
Which side effect is most important for the patient to monitor for, given the mechanism of action of this drug? *

Weight loss.

Hypoglycemia.

Vitamin B12 deficiency.

Excessive urination.

11. Mme Valérie Bouchard, 28 years old, is admitted for stabilization of her Type 1 Diabetes. The physician orders a "sliding scale" (correction scale) of insulin.
The order reads: Administer Humalog (Lispro) subcutaneously AC (before meals) based on CBG.

It is 11:45, and lunch trays have just arrived on the unit. Mme Bouchard’s CBG is 14.5 mmol/L.

Question:
When is the optimal time to administer this injection? *

30 to 45 minutes before she starts eating.

Immediately when the tray is in front of her, or within 15 minutes of eating.

After she has finished the entire meal to ensure she eats.

At bedtime, to correct the daytime high.

12. M. Robert Fortin, 65 years old, comes to the clinic for a foot ulcer check. He has a 15-year history of diabetes and peripheral neuropathy. He tells the nurse, "My feet are always cold at night, so I've started using a hot water bottle in bed."

Question:
What is the nurse’s priority response? *

"That is a good idea to improve circulation to your toes."

"Make sure you test the water temperature with your elbow or thermometer, not your hand or foot."

"You should stop using the hot water bottle immediately because you may burn yourself without feeling it."

"Soaking your feet in hot water would be more effective than a bottle."

13. Mlle Émilie Côté, 22 years old, reports that her blood glucose is high every morning (around 16 mmol/L) when she wakes up, even though it is normal when she goes to bed. The nurse suspects the Somogyi Effect.
The physician asks the nurse to instruct the patient on how to confirm this.

Question:
What instruction should the nurse give? *

"Check your blood sugar at 3:00 AM for a few nights."

"Eat a large high-carbohydrate snack before bed."

"Increase your bedtime basal insulin dose."

"Measure your ketones every morning."

14. Mme Claire Tremblay, 68 years old, is hospitalized for a hip fracture. She has Type 2 diabetes managed at home with Metformin (Glucophage) 500 mg PO BID. It is 08:00, and breakfast has just been served. The nurse checks her capillary blood glucose (CBG) and the result is 4.0 mmol/L. The patient is alert, asymptomatic, and ready to eat.

Question:
How should the nurse proceed regarding the administration of Metformin? *

Hold the medication and notify the physician immediately.

Administer the medication immediately with her breakfast.

Hold the medication and give 175mL of orange juice first.

Give only half the dose (250 mg) to prevent a further drop in blood sugar.

15. M. Roger Gagnon, 72 years old, is newly prescribed Glyburide (Diabeta) 5 mg PO daily. The nurse administers the first dose at 08:00. M. Gagnon states, "I'm not very hungry this morning; I think I'll just have a black coffee and go for a walk."

Question:
What is the nurse’s priority advice to the patient at this moment? *

"That is fine, the medication works best on an empty stomach."

"Drink at least 500 mL of water before your walk to prevent dehydration."

"You must eat a meal containing carbohydrates within 15 to 30 minutes."

"Take a second pill when you return from your walk if you eat then."

16. M. Sylvain Roy, 45 years old, comes to the clinic for a routine diabetes check-up. He claims his home glucose readings are always "perfect," around 6.0 mmol/L every morning. However, the nurse reviews his laboratory results: HbA1c (Glycated Hemoglobin) is 9.8%.

Question:
How should the nurse interpret these findings to the patient? *

"Your meter at home is likely broken and needs to be replaced."

"You are managing your diabetes well, but the lab made an error."

"While your morning fasting sugar is good, your average blood sugar over the last 3 months has been dangerously high."

"You likely have low iron levels which is causing a false high result."

17. Mme Isabelle Fortin, 24 years old, has Type 1 diabetes. She plays in a competitive soccer league. Her game starts in 30 minutes. Her current blood glucose is 6.2 mmol/L. She asks the nurse if she needs to do anything before running onto the field.

Question:
What is the nurse’s best recommendation? *

"Do not eat anything; your blood sugar is in the perfect target range."

"Inject 2 units of rapid-acting insulin to prevent a stress-induced spike."

"Consume a snack with 15–30 grams of carbohydrates and protein before playing."

"Do not play today; exercise is dangerous if your sugar is below 7.0 mmol/L."

18. M. Marc Dubé, 55 years old, requires insulin instruction. He is prescribed a mixture of NPH (cloudy) and Regular (clear) insulin to be taken in the same syringe. The nurse is observing M. Dubé prepare the injection.

Question:
Which action by the patient indicates that he understands the correct "Clear before Cloudy" technique? *

He draws up the NPH (cloudy) insulin first, then the Regular (clear).

He injects air into the Regular vial, then injects air into the NPH vial.

He injects air into the NPH vial, injects air into the Regular vial, and then draws up the Regular insulin.

He shakes the NPH vial vigorously to mix the solution before drawing.

19. Mme Claudine Bouchard, 60 years old, has Type 2 diabetes and COPD. She is admitted for an exacerbation of COPD and is started on high-dose IV Solu-Medrol (Methylprednisolone). Her home insulin dose is usually 10 units of Lantus at bedtime. The nurse notes her blood glucose is now consistently 18–20 mmol/L.

Question:
What is the primary physiological cause of this hyperglycemia? *

The stress of being in the hospital is causing the liver to release glucagon.

Corticosteroids cause significant insulin resistance and increase hepatic glucose production.

The patient is likely eating unauthorized sugary foods from the cafeteria.

The COPD infection has destroyed the beta cells of the pancreas.

20. M. Jean-Luc Morin, 48 years old, is obese (BMI 36) and presents for a physical exam. While assessing the neck, the nurse notes a dark, velvety, thickened patch of skin on the back of the neck and axillae. The patient says, "I've scrubbed it, but the dirt won't come off."

Question:
What is the clinical significance of this finding? *

It is a fungal infection common in diabetes requiring antifungal cream.

It is Acanthosis Nigricans, a hallmark physical sign of insulin resistance.

It indicates poor hygiene which puts the patient at risk for foot ulcers.

It is a reaction to sunlight caused by oral diabetic medications.

21. Mme Valérie Lefebvre, 30 years old, uses an insulin pump. She arrives at the ER with nausea, vomiting, and abdominal pain. Her BG is 24 mmol/L and she has moderate ketones in her urine. She states, "My pump site feels a bit itchy and wet."

Question:
What is the nurse’s priority intervention regarding insulin delivery? *

Increase the basal rate on the pump by 50%.

Administer a bolus via the pump immediately.

Change the infusion set to a new site on the abdomen.

Disconnect the pump and administer insulin via manual subcutaneous injection or IV.

22. M. Guillaume Côté, a 21-year-old university student with Type 1 Diabetes, asks the nurse about drinking alcohol at parties. He asks, "Can I drink beer with my friends?"

Question:
What is the most critical safety teaching regarding alcohol and diabetes? *

"Yes, but you must inject extra insulin because alcohol is sugar."

"Alcohol inhibits the liver from releasing glucose, so you are at risk for delayed hypoglycemia."

"You should only drink hard liquor like vodka because it has no carbs."

"Alcohol acts like a stimulant and will cause your blood sugar to spike for 24 hours."

23. M. Robert Pelletier, 58 years old, has had Type 2 diabetes for 15 years. His urinalysis reveals microalbuminuria. His blood pressure is 145/90 mmHg. The physician prescribes Ramipril (Altace). M. Pelletier asks, "Why do I need a blood pressure pill? I feel fine."

Question:
What is the nurse’s best explanation? *

"This medication is primarily to lower your heart rate."

"This medication protects your kidneys from further diabetic damage."

"It helps the Metformin work more effectively."

"It will cure the protein leaking in your urine."

24. M. André Lalonde, 60 years old, has Type 1 diabetes and recently suffered a myocardial infarction. He is prescribed Metoprolol (Lopressor), a beta-blocker, in addition to his insulin regimen. During a follow-up visit, the nurse teaches him about potential drug interactions.

Question:
What specific warning must the nurse provide regarding the interaction between beta-blockers and hypoglycemia? *

"The heart medication will cause your blood sugar to rise significantly."

"The medication masks the warning signs of low sugar, such as shaking and palpitations."

"Beta-blockers prevent the insulin from working, leading to ketoacidosis."

"You must stop the heart medication if your blood sugar drops below 4.0 mmol/L."

25. Mme Sylvie Poirier, 45 years old, takes Lantus (Insulin Glargine) once daily. She is planning a 2-week road trip in July. She asks the nurse, "How should I keep my insulin while I am driving in the hot car?"

Question:
What is the correct storage instruction? *

"Keep the insulin in the glove compartment to keep it out of direct sunlight."

"Place the insulin directly on the ice in a cooler to keep it near freezing."

"Insulin is stable up to 40°C, so it is safe anywhere in the car."

"Keep the insulin in a cooler bag, but ensure it does not touch the ice packs directly."

26. Mme Lise Levesque, 55 years old, has had Type 1 Diabetes for 30 years. She presents with complaints of early satiety (feeling full after a few bites), abdominal bloating, and occasional vomiting of undigested food hours after eating. The physician suspects Diabetic Gastroparesis.

Question:
Which dietary intervention should the nurse recommend to manage these symptoms? *

"Eat three large meals a day to ensure adequate calorie intake."

"Increase your fiber intake significantly to help move the bowels."

"Eat small, frequent meals that are low in fat and low in fiber."

"Drink fluids only with meals to help wash the food down."

27. M. Claude Turcotte, 50 years old, is an insulin-dependent diabetic who drives a delivery truck. He asks the nurse about the legal safety regulations for driving.

Question:
What is the standard safety rule regarding blood glucose testing and driving? *

"You only need to test if you feel dizzy."

"Test immediately before driving and every 4 hours while driving."

"If your blood sugar is 4.5 mmol/L, you are safe to drive immediately."

"You must not drive for 24 hours after a mild hypoglycemic event."

28. M. Patrice Rioux, 62 years old, with Type 2 Diabetes, is prescribed a new medication: Canagliflozin (Invokana), an SGLT2 inhibitor.

The nurse provides teaching about potential adverse effects.

Question:
Which specific symptom should M. Rioux report to his doctor immediately? *

Dry cough.

Swelling of the ankles.

Itching or burning in the genital area.

Metallic taste in the mouth.

30. Mme Diane Dubreuil, 35 years old, has Type 1 Diabetes and uses Basaglar (Insulin Glargine) 20 units at bedtime and rapid insulin with meals. She is admitted for elective surgery tomorrow morning and is NPO (Nothing by Mouth) from midnight.
The physician orders: "Hold mealtime insulin. Give 80% of bedtime Basaglar dose."

The nurse asks a colleague for verification.

Question:
Why is the basal (long-acting) insulin continued even when the patient is NPO? *

To prevent the patient from going into Diabetic Ketoacidosis (DKA).

To cover the glucose from the IV Dextrose fluids.

It is a mistake; all insulin should be held when NPO.

To prevent the surgical wound from getting infected.

31. M. Simon Cloutier, 48 years old, is newly diagnosed with Type 2 Diabetes and started on Metformin 500 mg BID. Two days later, he calls the clinic complaining of loose stools, nausea, and abdominal cramping. He wants to stop the drug.

Question:
What is the nurse’s best response? *

"Stop the medication immediately and go to the ER; this is an allergic reaction."

"These are common side effects that usually resolve in 2 weeks; try taking it with food."

"You should take an antacid like Tums with the pill to coat your stomach."

"This means the dose is too low and your body is rejecting it."

32. M. Yves Lapierre, 70 years old, has diabetes and peripheral vascular disease. He asks the nurse to cut his toenails because they are "thick and yellow." On assessment, the nurse notes the nails are hypertrophic (thickened) and curved.

Question:
What is the nurse’s appropriate action? *

Soak the feet in hot water for 30 minutes, then cut the nails with clippers.

File the nails straight across using an emery board, but do not cut them.

Use a scalpel to thin the nail plate before trimming.

Refer the patient to a podiatrist or specialized foot care nurse.

33. Mme Nicole Jean, 52 years old, presents with a blood glucose of 22 mmol/L. She has been undiagnosed and untreated for months. She complains, "My vision has become very blurry over the last week. Do I need new glasses?"

Question:
How should the nurse explain the vision change? *

"High sugar levels cause permanent damage to the optic nerve."

"The high sugar causes the lens of your eye to swell with fluid, causing temporary blurriness."

"You have developed cataracts which require immediate surgery."

"It is likely a coincidence and unrelated to your diabetes."

34. Mlle Chloé Giroux, 10 years old, was diagnosed with Type 1 Diabetes three months ago. Her parents call the clinic stating, "We barely have to give her any insulin lately, and her sugars are normal. Is she cured?"

Question:
What is the nurse’s best explanation for this phase? *

"This is the 'Honeymoon Phase,' where the pancreas temporarily recovers some function."

"The diagnosis was likely incorrect, and she actually has Type 2 diabetes."

"She is growing fast, so her body is using up the sugar more efficiently."

"You should stop testing her blood sugar since she is stable."