DIABETES EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS
WITH EXPLANATIONS 2024/2025
UPDATE (ALREADY GRADED A+)
A nurse reviews the laboratory results of a client who is receiving intravenous insulin.
Which should alert the nurse to intervene immediately?
a. Serum chloride level of 98 mmol/L
b. Serum calcium level of 8.8 mg/dL
c. Serum sodium level of 132 mmol/L
d. Serum potassium level of 2.5 mmol/L - ANS: D
Insulin activates the sodium-potassium ATPase pump, increasing the movement of
potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia.
In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium.
The chloride level is normal. The calcium and sodium levels are slightly low, but this
would not be related to hyperglycemia and insulin administration.
A nurse teaches a client with diabetes mellitus about sick day management. Which
statement should the nurse include in this clients teaching?
a. When ill, avoid eating or drinking to reduce vomiting and diarrhea.
b. Monitor your blood glucose levels at least every 4 hours while sick.
c. If vomiting, do not use insulin or take your oral antidiabetic agent.
d. Try to continue your prescribed exercise regimen even if you are sick. - ANS: B
When ill, the client should monitor his or her blood glucose at least every 4 hours. The
client should continue taking the medication regimen while ill. The client should continue
to eat and drink as tolerated but should not exercise while sick.
A nurse assesses a client who is being treated for hyperglycemic-hyperosmolar state
(HHS). Which clinical manifestation indicates to the nurse that the therapy needs to be
adjusted?
a. Serum potassium level has increased.
b. Blood osmolarity has decreased.
c. Glasgow Coma Scale score is unchanged.
d. Urine remains negative for ketone bodies. - ANS: C
A slow but steady improvement in central nervous system functioning is the best
indicator of therapy effectiveness for HHS. Lack of improvement in the level of
consciousness may indicate inadequate rates of fluid replacement. The Glasgow Coma
Scale assesses the clients state of consciousness against criteria of a scale including
,best eye, verbal, and motor responses. An increase in serum potassium, decreased
blood osmolality, and urine negative for ketone bodies do not indicate adequacy of
treatment.
A nurse cares for a client who has diabetes mellitus. The nurse administers 6 units of
regular insulin and 10 units of NPH insulin at 0700. At which time should the nurse
assess the client for potential problems related to the NPH insulin?
a. 0800
b. 1600
c. 2000
d. 2300 - ANS: B
Neutral protamine Hagedorn (NPH) is an intermediate-acting insulin with an onset of 1.5
hours, peak of 4 to 12 hours, and duration of action of 22 hours. Checking the client at
0800 would be too soon. Checking the client at 2000 and 2300 would be too late. The
nurse should check the client at 1600.
After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients
understanding. Which statement made by the client indicates a need for additional
teaching?
a. I need to have an annual appointment even if my glucose levels are in good control.
b. Since my diabetes is controlled with diet and exercise, I must be seen only if I am
sick.
c. I can still develop complications even though I do not have to take insulin at this time.
d. If I have surgery or get very ill, I may have to receive insulin injections for a short
time. - ANS: B
Clients with diabetes need to be seen at least annually to monitor for long-term
complications, including visual changes, microalbuminuria, and lipid analysis. The client
may develop complications and may need insulin in the future.
When teaching a client recently diagnosed with type 1 diabetes mellitus, the client
states, I will never be able to stick myself with a needle. How should the nurse respond?
a. I can give your injections to you while you are here in the hospital.
b. Everyone gets used to giving themselves injections. It really does not hurt.
c. Your disease will not be managed properly if you refuse to administer the shots.
d. Tell me what it is about the injections that are concerning you. - ANS: D
Devote as much teaching time as possible to insulin injection and blood glucose
monitoring. Clients with newly diagnosed diabetes are often fearful of giving themselves
injections. If the client is worried about giving the injections, it is best to try to find out
what specifically is causing the concern, so it can be addressed. Giving the injections
for the client does not promote self-care ability. Telling the client that others give
themselves injections may cause the client to feel bad. Stating that you dont know
another way to manage the disease is dismissive of the clients concerns.
A nurse assesses a client with diabetes mellitus who self-administers subcutaneous
insulin. The nurse notes a spongy, swelling area at the site the client uses most
frequently for insulin injection. Which action should the nurse take?
,a. Apply ice to the site to reduce inflammation.
b. Consult the provider for a new administration route.
c. Assess the client for other signs of cellulitis.
d. Instruct the client to rotate sites for insulin injection. - ANS: D
The clients tissue has been damaged from continuous use of the same site. The client
should be educated to rotate sites. The damaged tissue is not caused by cellulitis or any
type infection, and applying ice may cause more damage to the tissue. Insulin can only
be administered subcutaneously and intravenously. It would not be appropriate or
practical to change the administration route.
A nurse reviews the medication list of a client recovering from a computed tomography
(CT) scan with IV contrast to rule out small bowel obstruction. Which medication should
alert the nurse to contact the provider and withhold the prescribed dose?
a. Pioglitazone (Actos)
b. Glimepiride (Amaryl)
c. Glipizide (Glucotrol)
d. Metformin (Glucophage) - ANS: D
Glucophage should not be administered when the kidneys are attempting to excrete IV
contrast from the body. This combination would place the client at high risk for kidney
failure. The nurse should hold the metformin dose and contact the provider. The other
medications are safe to administer after receiving IV contrast.
After teaching a client who is newly diagnosed with type 2 diabetes mellitus, the nurse
assesses the clients understanding. Which statement made by the client indicates a
need for additional teaching?
a. I should increase my intake of vegetables with higher amounts of dietary fiber.
b. My intake of saturated fats should be no more than 10% of my total calorie intake.
c. I should decrease my intake of protein and eliminate carbohydrates from my diet.
d. My intake of water is not restricted by my treatment plan or medication regimen. -
ANS: C
The client should not completely eliminate carbohydrates from the diet, and should
reduce protein if microalbuminuria is present. The client should increase dietary intake
of complex carbohydrates, including vegetables, and decrease intake of fat. Water does
not need to be restricted unless kidney failure is present.
A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed
an intensified insulin regimen:
Fasting blood glucose: 75 mg/dL
Postprandial blood glucose: 200 mg/dL
Hemoglobin A1c level: 5.5%
How should the nurse interpret these laboratory findings?
a. Increased risk for developing ketoacidosis
b. Good control of blood glucose
c. Increased risk for developing hyperglycemia
d. Signs of insulin resistance - ANS: B
, The client is maintaining blood glucose levels within the defined ranges for goals in an
intensified regimen. Because the clients glycemic control is good, he or she is not at
higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin
resistance.
A nurse prepares to administer insulin to a client at 1800. The clients medication
administration record contains the following information:
Insulin glargine: 12 units daily at 1800
Regular insulin: 6 units QID at 0600, 1200, 1800, 2400
Based on the clients medication administration record, which action should the nurse
take?
a. Draw up and inject the insulin glargine first, and then draw up and inject the regular
insulin.
b. Draw up and inject the insulin glargine first, wait 20 minutes, and then draw up and
inject the regular insulin.
c. First draw up the dose of regular insulin, then draw up the dose of insulin glargine in
the same syringe, mix, and inject the two insulins together.
d. First draw up the dose of insulin glargine, then draw up the dose of regular insulin in
the same syringe, mix, and inject the two insulins together. - ANS: A
Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing
results in an unpredictable alteration in the onset of action and time to peak action. The
correct instruction is to draw up and inject first the glargine and then the regular insulin
right afterward.
A nurse prepares to administer prescribed regular and NPH insulin. Place the nurses
actions in the correct order to administer these medications.
1. Inspect bottles for expiration dates.
2. Gently roll the bottle of NPH between the hands.
3. Wash your hands.
4. Inject air into the regular insulin.
5. Withdraw the NPH insulin.
6. Withdraw the regular insulin.
7. Inject air into the NPH bottle.
8. Clean rubber stoppers with an alcohol swab.
a. 1, 3, 8, 2, 4, 6, 7, 5
b. 3, 1, 2, 8, 7, 4, 6, 5
c. 8, 1, 3, 2, 4, 6, 7, 5
d. 2, 3, 1, 8, 7, 5, 4, 6 - ANS: B
After washing hands, it is important to inspect the bottles and then to roll the NPH to mix
the insulin. Rubber stoppers should be cleaned with alcohol after rolling the NPH and
before sticking a needle into either bottle. It is important to inject air into the NPH bottle
before placing the needle in a regular insulin bottle to avoid mixing of regular and NPH
insulin. The shorter-acting insulin is always drawn up first.
A nurse reviews the chart and new prescriptions for a client with diabetic ketoacidosis:
Vital Signs and Assessment:
