Diabetes Mellitus & Insulin Management: Solved Nursing Quiz
Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia and is a staple topic in every nursing competitive exam. In today's Daily Nursing Mock Test, we cover the entire spectrum of Diabetes Management.
This comprehensive quiz includes questions on differentiating Type 1 vs. Type 2 Diabetes, acute complications like Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS). We also focus on Insulin Therapy (Types, administration, peaks) and priority nursing interventions for Hypoglycemia. Master the care of diabetic patients with these high-yield MCQs.
Which Hemoglobin A1c (HbA1c) level is considered diagnostic for Diabetes Mellitus according to ADA guidelines?
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✅ Answer: C
Rationale: ionale: Answer C is correct because an HbA1c level of 6.5% or higher indicates diabetes. Option A is normal (non-diabetic). Option B indicates Pre-diabetes (impaired glucose tolerance). Option D indicates poorly controlled diabetes but the diagnostic threshold is 6.5%.
When teaching a patient about insulin injection sites, the nurse explains that insulin is absorbed most rapidly from which area?
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✅ Answer: C
Rationale: ionale: Answer C is correct because the abdomen has the fastest and most consistent rate of absorption for subcutaneous insulin. Option B and D have slower absorption rates. Option A is not a primary site for self-administration and has variable absorption.
The "Classic Triad" of symptoms associated with the onset of Type 1 Diabetes Mellitus includes:
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✅ Answer: A
Rationale: ionale: Answer A is correct because the 3 Ps—Polyuria (excessive urination), Polydipsia (excessive thirst), and Polyphagia (excessive hunger)—are the hallmark signs of hyperglycemia. Option B is incorrect because Type 1 usually causes weight loss, not gain.
Which of the following clinical manifestations is most indicative of Hypoglycemia?
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✅ Answer: B
Rationale: ionale: Answer B is correct because hypoglycemia stimulates the sympathetic nervous system, causing sweating (cool/clammy skin), tachycardia, and tremors. Options A, C, and D are classic signs of Hyperglycemia or Diabetic Ketoacidosis (DKA).
Which type of insulin is the only one approved for Intravenous (IV) administration during a DKA emergency?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Regular Insulin (Short-acting) is the only formulation stable and safe for IV use to rapidly lower blood sugar. Option A (Intermediate) and Option C (Long-acting) are formulations that cannot be given IV.
A patient with Type 2 Diabetes is scheduled for a CT scan with contrast dye. Which oral hypoglycemic agent must be withheld 48 hours before and after the procedure?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Metformin combined with iodine-based contrast dye increases the risk of Lactic Acidosis and acute kidney injury. Options A, C, and D do not carry this specific risk with contrast media.
The nurse is instructing a patient on how to mix Regular insulin and NPH insulin in the same syringe. What is the correct sequence?
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✅ Answer: C
Rationale: ionale: Answer C is correct because the mnemonic is "Cloudy, Clear, Clear, Cloudy." Air into NPH (cloudy), Air into Regular (clear), Draw Regular (clear), Draw NPH (cloudy). This prevents contaminating the clear Regular insulin with the cloudy NPH.
Which breathing pattern is characteristic of a patient with Diabetic Ketoacidosis (DKA) attempting to compensate for metabolic acidosis?
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✅ Answer: C
Rationale: ionale: Answer C is correct because Kussmaul respirations are deep and rapid breaths intended to blow off CO2 (acid) to correct metabolic acidosis. Option A is related to heart failure/brain damage. Option B is related to CNS damage.
What is the primary cause of Type 1 Diabetes Mellitus?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Type 1 DM is an autoimmune condition where the body attacks beta cells, resulting in absolute insulin deficiency. Options A, C, and D are associated with the pathophysiology or risk factors of Type 2 Diabetes.
A patient experiences morning hyperglycemia. The nurse notes the patient had hypoglycemia at 2:00 AM. This phenomenon is known as:
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✅ Answer: B
Rationale: ionale: Answer B is correct because the Somogyi Effect is rebound hyperglycemia following an episode of hypoglycemia (often at night). Option A, Dawn Phenomenon, is morning hyperglycemia due to natural hormonal surges (GH/Cortisol), without preceding hypoglycemia.
A patient is admitted with Diabetic Ketoacidosis (DKA). Which of the following is the priority nursing intervention during the initial phase of treatment?
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✅ Answer: C
Rationale: ionale: Answer C is correct because rehydration with IV fluids (0.9% NS) is the immediate priority to restore perfusion and flush out glucose. Option A is incorrect because potassium is added only after urine output is established. Option B is incorrect because IV insulin is preferred over subcutaneous in DKA.
What is the normal Fasting Blood Glucose (FBG) level in a healthy adult?
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✅ Answer: A
Rationale: ionale: Answer A is correct because the standard normal range for fasting blood glucose is 70-100 mg/dL (some labs use up to 110). Option B indicates Pre-diabetes or Diabetes. Option C indicates Hypoglycemia.
Which instruction is most appropriate for a diabetic patient regarding foot care?
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✅ Answer: D
Rationale: ionale: Answer D is correct because daily inspection allows early detection of injuries due to neuropathy. Option A is incorrect because soaking and hot water risk burns/maceration. Option B is incorrect due to injury risk. Option C is incorrect because nails should be cut straight across to prevent ingrown nails.
Insulin Glargine (Lantus) is classified as which type of insulin?
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✅ Answer: D
Rationale: ionale: Answer D is correct because Glargine is a long-acting basal insulin with a duration of 24 hours and no peak. Option A (Lispro), Option B (Regular), and Option C (NPH) have shorter durations and distinct peaks.
A conscious patient with Type 1 Diabetes presents with tremors and a blood glucose of 55 mg/dL. What is the immediate nursing action?
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✅ Answer: B
Rationale: ionale: Answer B is correct because the patient is conscious; the "Rule of 15" states to give 15g carbs (e.g., 4 oz juice) immediately. Option A is used only if the patient is unconscious. Option C would worsen the hypoglycemia.
Which class of oral hypoglycemic agents works primarily by stimulating the pancreas to release more insulin?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Sulfonylureas act by stimulating beta cells in the pancreas to secrete insulin. Option A works by decreasing liver glucose production. Option C delays carb absorption in the gut.
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) is distinguished from Diabetic Ketoacidosis (DKA) by the absence of:
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✅ Answer: C
Rationale: ionale: Answer C is correct because HHNS occurs in Type 2 diabetes where there is just enough insulin to prevent fat breakdown (ketosis), but not enough to prevent hyperglycemia. Options A, B, and D are present in both conditions.
A patient on insulin therapy asks what site to use for injection before going for a jog. The nurse should recommend avoiding:
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✅ Answer: C
Rationale: ionale: Answer C is correct because exercising the muscle group (thighs) where insulin was injected increases blood flow and accelerates absorption, risking hypoglycemia. Option A (Abdomen) is the preferred site in this scenario.
Which microvascular complication is the leading cause of end-stage renal disease in diabetic patients?
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✅ Answer: C
Rationale: ionale: Answer C is correct because Diabetic Nephropathy damages the glomeruli in the kidneys due to chronic hyperglycemia. Option A affects eyes. Option B affects nerves. Option D is a macrovascular complication.
When screening for Gestational Diabetes Mellitus (GDM), the Oral Glucose Tolerance Test (OGTT) is typically performed at which gestation?
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✅ Answer: B
Rationale: ionale: Answer B is correct because placental hormones causing insulin resistance peak around 24-28 weeks. Testing earlier is done only for high-risk women.
A patient with diabetes is prescribed Metformin. The nurse should warn the patient about which common side effect?
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✅ Answer: C
Rationale: ionale: Answer C is correct because GI symptoms (nausea, diarrhea, bloating) are the most common side effects of Metformin. Option A and B are uncommon with Metformin alone (it is weight neutral and rarely causes hypo).
What is the recommended "Sick Day Rule" for a diabetic patient who has the flu?
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✅ Answer: B
Rationale: ionale: Answer B is correct because infection/stress increases blood glucose (cortisol release), so frequent monitoring is vital. Option A is dangerous because insulin needs often increase during illness even if intake decreases. Fluids should be increased, not restricted.
Failure to rotate insulin injection sites can lead to which local complication?
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✅ Answer: B
Rationale: ionale: Answer B is correct because repeated injections in the same spot cause lipodystrophy (fatty lumps), which impairs insulin absorption. Option A involves veins. Option C is bleeding.
A patient is found unconscious with a medic alert bracelet indicating Type 1 Diabetes. No IV access is available. What is the appropriate treatment?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Glucagon promotes glycogenolysis to raise blood sugar when the patient cannot swallow and has no IV. Option A poses an aspiration risk in an unconscious patient. Option C would kill the patient (worsening hypoglycemia).
Which laboratory value indicates that a patient has "Pre-diabetes" (Impaired Fasting Glucose)?
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✅ Answer: B
Rationale: ionale: Answer B is correct because an FBG of 100-125 mg/dL indicates Pre-diabetes. 126 mg/dL or higher on two occasions is diagnostic for Diabetes. Option A is normal.
Diabetic patients are at high risk for "Silent Ischemia" (heart attack without pain) primarily due to:
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✅ Answer: A
Rationale: ionale: Answer A is correct because Cardiac Autonomic Neuropathy damages the nerves that sense pain in the heart, masking the classic chest pain of myocardial infarction.
Which fruit-like odor on the breath is a classic sign of Diabetic Ketoacidosis?
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✅ Answer: B
Rationale: ionale: Answer B is correct because the breakdown of fats produces ketones (acetone), which are volatile and exhaled, causing a fruity or nail-polish remover smell. Option A is associated with renal failure.
Which of the following insulins appears "Cloudy" in the vial?
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✅ Answer: B
Rationale: ionale: Answer B is correct because NPH (Neutral Protamine Hagedorn) contains protamine, making it a suspension that looks cloudy. Options A, C, and D are clear solutions.
The nurse advises a diabetic patient to avoid drinking alcohol on an empty stomach because it can cause:
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✅ Answer: B
Rationale: ionale: Answer B is correct because the liver prioritizes metabolizing alcohol over gluconeogenesis. If glycogen stores are low (empty stomach), this blockage of glucose production leads to severe hypoglycemia.
A patient with diabetes reports a feeling of "walking on pins and needles" in the feet. This is a symptom of:
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✅ Answer: B
Rationale: ionale: Answer B is correct because paresthesia (pins and needles) is a classic sign of sensory nerve damage (Neuropathy) caused by chronic high blood sugar. Option A presents with claudication/pain.
Which test determines the average blood glucose level over the previous 3 months?
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✅ Answer: C
Rationale: ionale: Answer C is correct because glucose attaches to hemoglobin in red blood cells, which have a lifespan of about 120 days (3 months), providing a long-term picture of control. Option A, B, and D only measure glucose levels at a specific moment in time.
A patient with Type 2 Diabetes has a blood pressure of 145/95 mmHg. The nurse anticipates the prescription of which class of antihypertensive drugs that offers renal protection?
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✅ Answer: B
Rationale: ionale: Answer B is correct because ACE Inhibitors (e.g., Lisinopril) reduce intraglomerular pressure and slow the progression of diabetic nephropathy (kidney damage). Option A and D do not offer the same level of specific renal protection in diabetics.
In a Glucose Tolerance Test (GTT), a 2-hour plasma glucose value of greater than or equal to what level is diagnostic for Diabetes?
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✅ Answer: D
Rationale: ionale: Answer D is correct because according to WHO and ADA criteria, a 2-hour post-load glucose ≥ 200 mg/dL confirms the diagnosis. 140-199 mg/dL indicates Impaired Glucose Tolerance (Pre-diabetes).
Which of the following insulins cannot be mixed with any other insulin in the same syringe?
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✅ Answer: C
Rationale: ionale: Answer C is correct because Glargine has a low pH (acidic) to allow for slow release; mixing it with other insulins would alter its pH and precipitation profile. Options A, B, and D can often be mixed under specific protocols.
A patient presents with Kussmaul respirations, dehydration, and abdominal pain. The nurse suspects Diabetic Ketoacidosis (DKA). Which arterial blood gas (ABG) finding supports this diagnosis?
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✅ Answer: B
Rationale: ionale: Answer B is correct because DKA causes Metabolic Acidosis: low pH (<7.35) and low Bicarbonate (HCO3 <22). Option A indicates Alkalosis. Option C is normal. Option D indicates Respiratory Alkalosis.
Which electrolyte disturbance is a potential fatal complication during the treatment of DKA with Insulin?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Insulin drives not only glucose but also Potassium into the cells, causing serum potassium levels to drop rapidly (Hypokalemia), risking arrhythmias. Option A occurs before treatment due to acidosis shifting K+ out of cells.
The nurse is assessing a patient for "Metabolic Syndrome" (Syndrome X). Which finding is a component of this syndrome?
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✅ Answer: A
Rationale: ionale: Answer A is correct because central obesity (High waist circumference) is a key criterion. Other criteria include High Triglycerides, Low HDL (not high), High BP, and High Fasting Glucose. Options B, C, and D are healthy values.
Which site is recommended for insulin injection to minimize the risk of exercise-induced hypoglycemia in a patient planning to play tennis?
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✅ Answer: C
Rationale: ionale: Answer C is correct because the abdomen is the least involved muscle group during tennis (compared to arms and legs), ensuring a consistent absorption rate. Options A and B involve active muscles, accelerating absorption.
What is the peak action time of NPH (Intermediate-acting) insulin?
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✅ Answer: B
Rationale: ionale: Answer B is correct because NPH insulin peaks between 4 to 12 hours after administration, which is when the risk for hypoglycemia is highest. Option A refers to Rapid/Short acting. Option D refers to Long acting.
A newborn born to a mother with uncontrolled Gestational Diabetes is at highest risk for which complication immediately after birth?
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✅ Answer: B
Rationale: ionale: Answer B is correct because the fetus produces high levels of insulin in response to the mother's high sugar. After birth, the sugar supply is cut off, but the infant's insulin is still high, causing severe hypoglycemia.
C-Peptide test is clinically used to differentiate between:
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✅ Answer: A
Rationale: ionale: Answer A is correct because C-Peptide is a byproduct of endogenous insulin production. It is low/absent in Type 1 (no insulin production) and normal/high in Type 2 (insulin resistance/production present).
Which nutrient should a diabetic patient restrict if they have developed early stages of Nephropathy (Microalbuminuria)?
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✅ Answer: C
Rationale: ionale: Answer C is correct because protein intake increases the workload on the kidneys. Restricting protein helps slow the progression of renal damage in nephropathy. Option A is restricted for glucose control, not specifically for nephropathy.
A patient taking Glipizide (Sulfonylurea) should be instructed to avoid which substance to prevent a "Disulfiram-like reaction"?
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✅ Answer: B
Rationale: ionale: Answer B is correct because First-generation sulfonylureas (and some second) can cause flushing, nausea, and palpitations when consumed with alcohol (Disulfiram effect). Also, alcohol increases hypoglycemia risk.
The "Rule of 15" for treating hypoglycemia involves giving 15g of carbohydrates and rechecking blood sugar in:
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✅ Answer: B
Rationale: ionale: Answer B is correct because it takes approximately 15 minutes for rapid-acting carbs to raise blood sugar. Rechecking too soon may lead to overtreatment.
Which of the following oral agents acts by delaying carbohydrate absorption in the intestine?
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✅ Answer: C
Rationale: ionale: Answer C is correct because Acarbose is an Alpha-glucosidase inhibitor that slows down the digestion of starch in the gut. Option A reduces liver glucose. Option B stimulates insulin. Option D increases sensitivity.
A patient with DKA is on an insulin drip. The nurse notes the blood glucose has dropped to 250 mg/dL. What order should the nurse expect next?
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✅ Answer: B
Rationale: ionale: Answer B is correct because when glucose drops to 250 mg/dL, Dextrose is added to the IV (e.g., D5NS) to prevent hypoglycemia while the insulin drip continues to clear the ketones/acidosis. Stopping insulin (Option A) would cause rebound ketosis.
Diabetic Retinopathy is characterized by the formation of:
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✅ Answer: C
Rationale: ionale: Answer C is correct because hyperglycemia damages retinal capillaries causing microaneurysms and neovascularization (new, weak vessels that bleed easily). Options A and B are also risks but C is the specific pathology of retinopathy.
Which hormone is secreted by the Alpha cells of the Pancreas?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Alpha cells secrete Glucagon (raises blood sugar). Beta cells secrete Insulin. Delta cells secrete Somatostatin.
A diabetic patient has a foot ulcer. Which factor most significantly delays wound healing in this patient?
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✅ Answer: B
Rationale: ionale: Answer B is correct because macrovascular and microvascular damage reduces blood supply (oxygen/nutrients) to the wound site, which is the primary physiological reason for poor healing. Option A causes the injury, but B prevents it from healing.
What is the primary action of Biguanides (e.g., Metformin)?
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✅ Answer: B
Rationale: ionale: Answer B is correct because Metformin primarily suppresses hepatic gluconeogenesis (liver glucose output) and improves insulin sensitivity. It does not stimulate the pancreas to make more insulin (Low hypoglycemia risk).
Which vitamin deficiency is associated with long-term Metformin use?
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✅ Answer: A
Rationale: ionale: Answer A is correct because Metformin interferes with the absorption of Vitamin B12 in the distal ileum, potentially leading to anemia or neuropathy. Options B, C, and D are not directly affected by Metformin absorption mechanisms.
A patient with Type 1 Diabetes plans to engage in strenuous exercise for 1 hour. The nurse should advise the patient to consume a carbohydrate snack if the pre-exercise blood glucose is below:
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✅ Answer: A
Rationale: ionale: Answer A is correct because exercise lowers blood glucose; starting with a level <100 mg/dL carries a high risk of hypoglycemia. Guidelines recommend a 15-30g carb snack if glucose is <100 mg/dL before activity.
The nurse observes "Acanthosis Nigricans" (dark, velvety patches of skin) on the neck of an obese adolescent. This finding is a strong clinical marker for:
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✅ Answer: B
Rationale: ionale: Answer B is correct because Acanthosis Nigricans is a cutaneous manifestation of hyperinsulinemia and insulin resistance, often preceding Type 2 Diabetes. Option A is autoimmune. Option D involves hyperpigmentation but not the velvety texture typical of this condition.
Which electrolyte abnormality should be monitored when a patient is receiving continuous IV insulin infusion?
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✅ Answer: C
Rationale: ionale: Answer C is correct because insulin drives not only glucose and potassium but also phosphate into the cells, leading to Hypophosphatemia and Hypokalemia. This is a crucial monitoring parameter in DKA/HHS management.
How long can an open vial of insulin be stored at room temperature (below 30°C) before it loses potency?
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✅ Answer: C
Rationale: ionale: Answer C is correct because once opened (punctured), an insulin vial can be kept at room temperature for up to 28 days. After this, potency decreases. Unopened vials should be refrigerated until the expiration date.
Which class of drugs masks the early signs of hypoglycemia (like tachycardia and palpitations)?
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✅ Answer: A
Rationale: ionale: Answer A is correct because Beta-blockers (e.g., Propranolol) block the sympathetic nervous system response (adrenaline), which is responsible for the warning signs of hypoglycemia like rapid heart rate and tremors. Sweating usually remains as a symptom.
SGLT-2 Inhibitors (e.g., Dapagliflozin) lower blood glucose by:
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✅ Answer: B
Rationale: ionale: Answer B is correct because Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors work in the renal tubules to block glucose reabsorption, causing glucose to be excreted in the urine (Glucosuria). Option A refers to TZDs. Option D refers to Sulfonylureas.
Gestational Diabetes typically resolves after delivery, but the mother has an increased lifetime risk of developing:
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✅ Answer: B
Rationale: ionale: Answer B is correct because GDM indicates an underlying insulin resistance; 35-60% of women with GDM develop Type 2 Diabetes within 10-20 years post-delivery. Option A is autoimmune and unrelated to GDM mechanisms.
Which rapid-acting insulin can be administered immediately before or even after a meal?
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✅ Answer: C
Rationale: ionale: Answer C is correct because Lispro has a very fast onset (15 mins); it is designed to manage the post-prandial spike and offers flexibility in timing relative to meals. Regular insulin (Option A) should be given 30 mins before meals.
For a diabetic patient, the recommended spacing between insulin injection sites within the same anatomical area is:
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✅ Answer: B
Rationale: ionale: Answer B is correct because spacing injections about 1 inch (2.5 cm) apart prevents lipohypertrophy and ensures consistent absorption. Option A is too close. Option D leads to erratic absorption rates.
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 & Insulin Therapy MCQs | Nursing Mock Test for NCLEX & NORCET){kind=link}
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