Diabetes Basics
Which condition is caused by autoimmune destruction of beta cells?
A. Type 1 diabetes
B. Type 2 diabetes
C. SIADH
D. Cushing syndrome
Answer: (A) Type 1 diabetes
Rationale: Type 1 diabetes occurs when beta cells are destroyed, causing little to no insulin production. These patients require insulin.
Which insulin is rapid acting?
A. Lispro
B. NPH
C. Glargine
D. Regular
Answer: (A) Lispro
Rationale: Lispro is rapid-acting insulin used for mealtime or correction coverage. It works quickly, so food should be available.
What is the priority for hypoglycemia in a conscious patient?
A. Give insulin
B. Give 15g carbs
C. Restrict fluids
D. Call surgery
Answer: (B) Give 15g carbs
Rationale: A conscious patient with hypoglycemia should receive fast-acting carbohydrate, then glucose should be rechecked in 15 minutes.
Which is a microvascular complication?
A. Stroke
B. Retinopathy
C. MI
D. PAD
Answer: (B) Retinopathy
Rationale: Retinopathy is small-vessel damage in the eyes. Stroke, MI, and PAD are macrovascular complications.
Which condition is more common in type 1 diabetes?
A. DKA
B. HHS
C. SIADH
D. Cushing syndrome
Answer: (A) DKA
Rationale: DKA is more common in type 1 diabetes because there is little to no insulin, causing fat breakdown, ketone production, and acidosis.
Which condition is primarily insulin resistance?
A. Type 1 diabetes
B. Type 2 diabetes
C. DI
D. Addison's disease
Answer: (B) Type 2 diabetes
Rationale: Type 2 diabetes begins mainly with insulin resistance. Over time, insulin production may also decrease.
A. Lispro
B. Glargine
C. Regular insulin
D. NPH
Answer: (C) Regular insulin
Rationale: regular insulin is the insulin used IV, especially for insulin drips in DKA and HHS.
Which finding indicates DKA?
A. Fruity breath
B. Bradycardia
C. Hypothermia
D. Edema
Answer: (A) Fruity breath
Rationale: DKA causes ketone buildup. Ketones can create a fruity breath odor, along with metabolic acidosis and Kussmaul respirations.
Which complication affects the kidneys?
A. Neuropathy
B. Retinopathy
C. Nephropathy
D. Angiopathy
Answer: (C) Nephropathy
Rationale: Nephropathy is kidney damage caused by chronic hyperglycemia damaging small renal blood vessels.
Which breathing pattern is associated with DKA?
A. Kussmaul respiration
B. Cheyne-Strokes respirations
C. Swallow slow respirations only
D. Stridor
Answer: (A) Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid breaths that help compensate for metabolic acidosis by blowing off CO2.
What are the three classic symptoms of diabetes?
A. Fever, chills, pain
B. Polyuria, polydipsia, polyphagia
C. Bradycardia, hypotension, fatigue
D. Nausea, vomiting, diarrhea
Answer: (B) Polyuria, Polydipsia, and Polyphagia
Rationale: High glucose causes osmotic diuresis, leading to frequent urination and thirst. Cells cannot use glucose properly, causing hunger.
What is the priority before giving rapid insulin?
A. Check potassium
B. Ensure meal is ready
C. Check temperature
D. Restrict fluids
Answer: (B) Ensure meal is ready
Rationale: rapid-acting insulin can quickly lower blood glucose. If the patient does not eat, hypoglycemia can occur.
Why is potassium monitored in DKA?
A. No reason
B. Insulin lowers potassium levels
C. Potassium stays the same
D. Potassium only affects kidneys
Answer: (B) Insulin lowers potassium levels
Rationale: Insulin pushes potassium back into cells, which can cause serum potassium to drop quickly and increase dysrhythmia risk.
Loss of sensation in feet is due to:
A. Retinopathy
B. Neuropathy
C. Nephropathy
D. Hypertension
Answer: (B) Neuropathy
Rationale: Diabetic neuropathy damages nerves, causing numbness, tingling, burning pain, and loss of protective sensation.
What is usually the first major treatment priority in DKA and HHS?
A. IV Fluids
B. Oral thyroid hormone
C. Fluid restriction
D. Antibiotics only
Answer: (A) IV Fluids
Rationale: Both DKA and HHS cause dehydration from osmotic diuresis. IV fluids help restore circulation before and during insulin therapy.
What does A1C reflect?
A. Blood sugar now
B. Blood sugar over 2-3 months
C. Kidney function
D. Thyroid function
Answer: (B) Blood sugar over 2-3 months
Rationale: A1C reflects the average amount of glucose attached to hemoglobin over the lifespan of red blood cells, about 2-3 months.
Which drug decreases liver glucose production?
A. Metformin
B. Glipizide
C. Insulin
D. PTU
Answer: (A) Metformin
Rationale: Metformin lowers glucose mainly by decreasing hepatic glucose production and improving insulin sensitivity.
Which condition has extreme dehydration and very high glucose without significant ketones?
A. DKA
B. HHS
C. Hypoglycemia
D. SIADH
Answer: (B) HHS
Rationale: HHS usually occurs in type 2 diabetes and causes very high glucose, severe dehydration, high serum osmolality, and altered mental status with minimal ketones.
What is most important for foot care?
A. Walk barefoot
B. Inspect daily
C. Use heating pads
D. Cut corns yourself
Answer: (B) Inspect daily
Rationale: Daily inspection helps catch wounds early. Neuropathy can prevent the patient from feeling injuries, so visual checks are essential.
Which teaching is safest for exercise with diabetes?
A. Exercise without checking glucose if symptomatic
B. Carry fast-acting carbohydrate
C. Skip meals before exercise
D. Inject insulin into the muscle being exercised
Answer: (B) Carry fast-acting carbohydrate
Rationale: Exercise can lower glucose and increase hypoglycemia risk, so patients should carry a quick source of sugar.
Why does polyuria occur in diabetes?
A. Insulin increases urine
B. Glucose pulls water into urine
C. Kidneys stop working
D. Sodium decreases
Answer: (B) Glucose pulls water into urine
Rationale: When blood glucose is high, excess glucose spills into the urine and pulls water with it, causing frequent urination.
Which drug causes glucose to be excreted in urine?
A. Metformin
B. Empagliflozin
C. Levothyroxine
D. Propranolol
Answer: (B) Empagliflozin
Rationale: Empagliflozin is an SGLT2 Inhibitor. It blocks glucose reabsorption in the kidneys, causing glucose to leave through urine.
Which symptoms is most concerning for hypoglycemia?
A. Hunger
B. Confusion
C. Sweating
D. Mild tremor
Answer: (B) Confusion
Rationale: Confusion shows the brain is not getting enough glucose. This can progress to seizures, loss of consciousness, and airway risk.
What prevents long-term complications best?
A. Avoid exercise
B. Tight shoes
C. Glucose control
D. High sugar intake
Answer: (C) Glucose control
Rationale: Chronic hyperglycemia damages blood vessels and nerves. Good glucose control lowers the risk of retinopathy, nephropathy, neuropathy, and vascular disease.
Which sick-day teaching is correct for a patient with diabetes?
A. Stop insulin whenever not eating.
B. Check glucose more often and stay hydrated
C. Avoid checking ketones when glucose is high
D. Ignore voimiting if glucose is normal
Answer: (B) Check glucose more often and stay hydrated
Rationale: Illness can raise glucose due to stress hormones, even with poor intake. Patients should monitor more often, hydrate, and follow sick-day instructions.