NCLEX practice questions: diabetes

Know insulin onset and peak, the signs of hypoglycemia and how to treat it, and the priorities in diabetic ketoacidosis.

1. Question 1

   In a long-term care facility, the nurse finds a client with type 2 diabetes who is unresponsive. Capillary glucose is 38 mg/dL. The client has no IV access. Which action should the nurse take?

   • A.Hold the next insulin dose and recheck glucose in 15 minutes
   • B.Place glucose gel between the cheek and gums
   • C.Give glucagon by intramuscular or subcutaneous injection
   • D.Pour orange juice slowly into the client's mouth
   Show answer and explanation

   Answer: C

   Severe hypoglycemia with loss of consciousness is an emergency. If there is no IV access, glucagon (injection or nasal) is given and the client is turned on the side because vomiting is common. Once awake and able to swallow, the client gets fast-acting carbohydrate followed by a snack with protein.

   • A. Holding insulin does nothing to raise a dangerously low glucose. Waiting can cause brain injury.
   • B. Any oral product is unsafe in an unresponsive client because of aspiration risk.
   • C. Glucagon raises blood glucose by releasing liver glycogen. It is the right choice when the client cannot swallow and has no IV line.
   • D. An unresponsive client cannot protect the airway. Liquids by mouth can be aspirated into the lungs.

   Key concept: Unconscious and hypoglycemic: nothing by mouth; give glucagon or IV dextrose.

   Tip: Can't swallow? Can't have juice — give glucagon.

2. Question 2

   The nurse is starting a continuous IV regular insulin infusion. Which practices help prevent a medication error? Select all that apply.

   Select all that apply.

   • A.Have a second nurse perform an independent double check of the drug, concentration and pump settings
   • B.Use a standard concentration prepared by the pharmacy
   • C.Program the smart pump using the drug library
   • D.Write the dose as '6U/hr' on the label
   • E.Accept verbal orders for rate changes whenever convenient
   • F.Label the IV tubing near the connection to the client
   Show answer and explanation

   Answer: A, B, C, F

   IV insulin is a high-alert medication: errors can cause severe harm. Safety strategies include standard concentrations, smart pumps with drug libraries, independent double checks, clear labeling, avoiding error-prone abbreviations such as 'U' and 'IU', and protocols for glucose monitoring.

   • A. Correct. Independent double checks are recommended for high-alert drugs such as IV insulin.
   • B. Correct. Standard concentrations reduce calculation errors.
   • C. Correct. Drug libraries set dose limits that alert the nurse to programming errors.
   • D. The abbreviation 'U' can be misread as 0 or 4. The word 'units' should be written out.
   • E. Verbal orders increase error risk. They are limited to urgent situations and must be read back.
   • F. Correct. Labeling the line prevents mix-ups when several infusions run at the same time.

   Key concept: High-alert drugs need layered safety: standard concentrations, smart pumps, double checks and clear labels.

   Tip: Never write 'U'; write 'units'.

3. Question 3

   A client's TPN bag is almost empty, and the pharmacy reports that the next bag will be delayed for 2 hours. The unit has a protocol for interrupted TPN. Which action should the nurse take?

   • A.Hang 10% dextrose in water at the same rate per protocol and monitor blood glucose
   • B.Stop the infusion and flush the line until the new bag arrives
   • C.Hang 0.9% sodium chloride at the same rate
   • D.Slow the current bag so it lasts until the new bag arrives
   Show answer and explanation

   Answer: A

   TPN contains a high concentration of dextrose. The body responds by producing more insulin. If TPN stops suddenly, insulin levels stay high and glucose falls quickly. Hanging 10% dextrose at the same rate bridges the gap until the new bag arrives.

   • A. Correct. D10W, given per protocol, supplies glucose and prevents rebound hypoglycemia when concentrated dextrose stops suddenly.
   • B. Stopping TPN suddenly can cause rebound hypoglycemia because the pancreas is still producing extra insulin.
   • C. Normal saline keeps the line open but contains no glucose, so it does not prevent hypoglycemia.
   • D. Slowing the rate reduces the glucose supply and the remaining volume is too small to last 2 hours safely.

   Key concept: Never stop TPN abruptly; if the bag is unavailable, hang D10W at the same rate and check blood glucose.

   Tip: No TPN? Hang D10 until it comes again.

4. Question 4

   A 25-year-old client was just diagnosed with type 1 diabetes. The client recently lost a job and has no health insurance. Which referrals are appropriate before discharge? Select all that apply.

   Select all that apply.

   • A.Diabetes self-management education program
   • B.Social worker to help apply for insurance and insulin assistance
   • C.Follow-up with a primary care or endocrinology provider
   • D.Hospice care
   • E.Inpatient rehabilitation facility
   • F.Adult day program
   Show answer and explanation

   Answer: A, B, C

   A new diagnosis of type 1 diabetes requires education, reliable access to insulin and supplies, and medical follow-up. Financial barriers must be addressed before discharge because missed insulin can lead to diabetic ketoacidosis.

   • A. Correct. Structured education helps the client learn insulin use, glucose monitoring and sick-day rules.
   • B. Correct. Insulin is essential and expensive. The social worker can help with coverage and assistance programs.
   • C. Correct. Ongoing medical follow-up is needed to adjust insulin and monitor for complications.
   • D. Type 1 diabetes is a chronic, manageable condition, not a terminal illness.
   • E. The client has no functional loss requiring intensive rehabilitation.
   • F. The client is a young, independent adult who does not need daytime supervision.

   Key concept: Referrals should address education, access to medications and follow-up for a new chronic illness.

   Tip: New diabetes: learn it, afford it, follow it up.

5. Question 5

   A nurse is teaching a client who will inject insulin at home how to dispose of used syringes. Which statement by the client shows understanding?

   • A."I'll recap each needle before I throw it in the kitchen trash."
   • B."I'll flush the needles down the toilet."
   • C."I'll put them in an empty soda can."
   • D."I'll put the used syringes in a heavy plastic laundry detergent bottle with a screw cap and label it 'Do not recycle.'"
   Show answer and explanation

   Answer: D

   At home, sharps go into an FDA-cleared sharps container or a heavy-duty plastic household container with a screw-on lid, labeled "Do not recycle." When it is about three-quarters full, it is sealed and disposed of according to local rules, such as drop-off sites or mail-back programs.

   • A. Recapping causes needlesticks, and loose sharps in household trash injure waste workers.
   • B. Needles damage plumbing and contaminate water systems.
   • C. Thin cans can be punctured and may be recycled by mistake.
   • D. A thick, puncture-resistant container with a tight lid is acceptable when an approved sharps container is not available. Labeling keeps it out of recycling.

   Key concept: Home sharps go in a strong, closed, labeled container, never loose in the trash or recycling.

   Tip: "Heavy bottle, tight cap, do not recycle."