Insulin
A 14-year-old with newly diagnosed Type 1 diabetes asks why they need insulin every day. Which response by the nurse best explains the need for lifelong insulin?
A. “You need insulin only when your sugar is too high.”
B. “Your pancreas no longer produces insulin.”
C. “Insulin helps prevent weight gain.”
D. “Insulin is only needed when you’re sick.”
B. “Your pancreas no longer produces insulin.”
Which client is most at risk for developing Type 2 diabetes?
A. A 16-year-old with a BMI of 21
B. A 35-year-old who walks daily
C. A 50-year-old with obesity and a sedentary job
D. A 28-year-old who has Hashimoto's thyroiditis
C. A 50-year-old with obesity and a sedentary job
A patient with Type 1 diabetes presents with abdominal pain, Kussmaul respirations, and blood glucose of 420 mg/dL. What is the priority diagnosis?
A. HHS
B. DKA
C. Hypoglycemia
D. Hyperinsulinemia
B. DKA
Which insulin is appropriate for IV administration during a diabetic emergency?
A. NPH
B. Lispro
C. Regular
D. Glargine
C. Regular
A diabetic client’s blood glucose rises every morning despite no late-night eating. What phenomenon does the nurse suspect?
A. Somogyi Effect
B. Insulin resistance
C. Dawn Phenomenon
D. Rebound hyperglycemia
C. Dawn Phenomenon
Which clinical finding would most concern the nurse in a patient with Type 1 diabetes who has missed insulin doses?
A. Bradycardia
B. Cool, clammy skin
C. Fruity breath and deep breathing
D. Swelling in the lower extremities
C. Fruity breath and deep breathing
A newly diagnosed Type 2 diabetic asks why insulin isn't prescribed. What is the nurse’s best explanation?
A. “Insulin is only used in hospital settings.”
B. “Your pancreas is still producing some insulin.”
C. “Insulin would lower your blood sugar too much.”
D. “You only need insulin if you become pregnant.”
B. “Your pancreas is still producing some insulin.”
Which of the following is most characteristic of HHS?
A. Ketones in urine
B. Rapid onset
C. Blood glucose >600 mg/dL without ketosis
D. Acetone breath
C. Blood glucose >600 mg/dL without ketosis
A nurse prepares to give rapid-acting insulin before a meal. When should it be administered?
A. 30 minutes before eating
B. At bedtime
C. Immediately after meals
D. Within 15 minutes of meal start
D. Within 15 minutes of meal start
A client has a low blood glucose at 2 AM and high glucose at 6 AM. What is the most likely cause?
A. Dawn Phenomenon
B. Somogyi Effect
C. Increased carbohydrate intake
D. Basal insulin deficiency
B. Somogyi Effect
A patient with Type 1 diabetes uses long-acting insulin once daily. What is the purpose of this type of insulin?
A. To lower glucose after meals
B. To cover insulin needs during exercise
C. To provide basal insulin coverage
D. To treat hypoglycemia quickly
C. To provide basal insulin coverage
A client with Type 2 diabetes is prescribed metformin. Which statement by the client requires further teaching?
A. “I’ll take this medication with food.”
B. “This will help my liver release more sugar.”
C. “It might upset my stomach at first.”
D. “I should stop this medication before a CT with contrast.”
B. “This will help my liver release more sugar.”
A nurse is reviewing labs for a client in DKA. Which electrolyte should be monitored closely during insulin therapy?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
B. Potassium
Which oral antidiabetic class increases insulin secretion and poses a hypoglycemia risk?
A. Biguanides
B. Sulfonylureas
C. DPP-4 inhibitors
D. SGLT2 inhibitors
B. Sulfonylureas
How can the nurse distinguish between the Somogyi Effect and Dawn Phenomenon?
A. Measure ketones in the urine
B. Check blood glucose at 10 PM
C. Check blood glucose at 2–3 AM
D. Review hemoglobin A1C
C. Check blood glucose at 2–3 AM
Which lab value would most support the diagnosis of Type 1 diabetes?
A. Random glucose of 180 mg/dL
B. A1C of 5.6%
C. Positive urine ketones
D. Low HDL cholesterol
C. Positive urine ketones
What is the primary difference between Type 1 and Type 2 diabetes?
A. Type 1 has insulin resistance
B. Type 2 causes diabetic ketoacidosis
C. Type 1 has complete insulin deficiency
D. Type 2 causes autoimmune destruction of beta cells
C. Type 1 has complete insulin deficiency
The nurse knows treatment of both DKA and HHS includes:
A. Oral hypoglycemic agents and corticosteroids
B. Insulin, fluid replacement, and electrolyte monitoring
C. NPO status and antibiotics
D. High-protein, high-fat diet
B. Insulin, fluid replacement, and electrolyte monitoring
A nurse is preparing a patient for a CT with contrast. The patient takes metformin. What is the priority action?
A. Double the dose for better glucose control
B. Administer insulin instead
A nurse is preparing a patient for a CT with contrast. The patient takes metformin. What is the priority action?
A. Double the dose for better glucose control
B. Administer insulin instead
C. Hold the metformin before and after the procedure
D. Encourage fluids and continue metformin
C. Hold the metformin before and after the procedure
A patient with diabetes experiences tremors, diaphoresis, and confusion. The blood glucose is 58 mg/dL. What is the priority action?
A. Recheck the glucose in 30 minutes
B. Notify the provider
C. Administer 15g of fast-acting carbohydrate
D. Give long-acting insulin
C. Administer 15g of fast-acting carbohydrate
Which symptom is most consistent with hypoglycemia?
A. Flushed, dry skin
B. Slow, deep respirations
C. Tremors and anxiety
D. Polyuria and polydipsia
C. Tremors and anxiety
A patient becomes unconscious due to hypoglycemia. What is the nurse's immediate action?
A. Place the patient in Trendelenburg position
B. Administer IM glucagon
C. Offer juice by mouth
D. Start oxygen therapy
B. Administer IM glucagon
A patient asks what puts them at risk for hypoglycemia. Which medication class is the nurse most concerned about?
A. Biguanides
B. Sulfonylureas
C. SGLT2 inhibitors
D. GLP-1 receptor agonists
B. Sulfonylureas
A client asks how to store their insulin pen when not in use. What is the correct response?
A. “Keep it in your purse.”
B. “Store it in the freezer.”
C. “Refrigerate it when not in use.”
D. “Keep it near a sunny window.”
C. “Refrigerate it when not in use.”
A diabetic client experiences frequent early morning hypoglycemia. Which insulin-related issue does the nurse suspect?
A. Taking insulin too late
B. Skipping evening snacks
C. Excessive nighttime insulin causing the Somogyi effect
D. Increased insulin resistance at night
C. Excessive nighttime insulin causing the Somogyi effect