Exam 4 NCLEX style questions
A nurse is educating a newly diagnosed diabetic patient. Which of the following statements
made by the patient indicates understanding of Type 1 Diabetes Mellitus?
A. "If I lose weight and exercise, I may be able to stop taking insulin."
B. "My pancreas produces insulin, but not enough to meet my needs."
C. "I will need to take insulin for the rest of my life."
D. "This type of diabetes usually develops in adulthood."
Answer: C.
Rationale:Type 1 Diabetes Mellitus is characterized by the complete absence of insulin
production. These patients are insulin-dependent for life. Choices A and B describe Type 2
DM, and D is false because Type 1 typically begins in childhood.
A patient with a strong family history of diabetes presents for a wellness check. The nurse
identifies which of the following findings as the greatest modifiable risk factor for
developing Type 2 Diabetes?
A. Family history of diabetes
B. Presence of hypertension
C. Sedentary lifestyle
D. History of viral illness
Answer: C.
Rationale:While genetics and hypertension are significant, physical inactivity is a modifiable
(changeable) risk factor. Increasing activity can reduce insulin resistance and delay onset of
Type 2 DM.
A nurse is reviewing the difference between Type 1 and Type 2 Diabetes Mellitus. Which of
the following correctly explains a pathophysiological difference?
A. Type 1 involves insulin resistance; Type 2 is complete beta-cell destruction.
B. Type 1 patients may still produce some insulin in the early stages.
C. Type 2 is associated with autoimmune beta-cell destruction.
D. Type 2 involves insulin resistance and relative insulin deficiency.
,Answer: D.
Rationale:Type 2 DM is characterized by insulin resistance and a relative lack of insulin.
Type 1 involves autoimmune destruction of beta cells. A and C are reversed, and B is
incorrect.
The nurse is caring for a client with newly diagnosed Type 2 Diabetes. Which intervention is
appropriate for initial management?
A. Begin basal-bolus insulin therapy immediately
B. Educate about carbohydrate counting and administer regular insulin
C. Encourage lifestyle changes and start oral hypoglycemic agents
D. Administer glucagon intramuscularly once daily
Answer: C.
Rationale:Initial treatment for Type 2 DM often includes diet, exercise, and oral medications
such as metformin. Insulin is usually reserved for later stages or severe cases. Glucagon is
used in hypoglycemia, not daily treatment.
A nurse is reviewing lab results of a patient with suspected diabetes. Which finding would
support a diagnosis of diabetes mellitus?
A. Hemoglobin A1c of 5.9%
B. Fasting blood glucose of 118 mg/dL
C. Random plasma glucose of 210 mg/dL with polyuria
D. 2-hour oral glucose tolerance test result of 135 mg/dL
Answer: C.
Rationale:A random plasma glucose ≥200 mg/dL with symptoms (e.g., polyuria) is diagnostic.
A1c of 5.9% and fasting glucose of 118 mg/dL are pre-diabetic, not diagnostic. OGTT of 135
is also in the prediabetic range.
A nurse is preparing a client for a fasting blood glucose test. Which of the following
instructions is most appropriate?
A. "You may eat a light meal up to 4 hours before the test."
B. "Drink a sugary drink 2 hours before the blood draw."
C. "Avoid food and drink, except water, for 8 hours before the test."
D. "Take your oral antidiabetic medication the morning of the test."
,Answer: C.
Rationale:Fasting blood glucose requires an 8-hour fast, with only water allowed.
Antidiabetic meds are typically held until after the blood draw to avoid false low results.
Which of the following statements by a client indicates correct understanding of the oral
glucose tolerance test?
A. "I'll fast for 24 hours before drinking the glucose solution."
B. "I'll eat mostly carbs for 3 days before the test, then fast for 8 hours."
C. "I need to avoid all carbs for 3 days before the test."
D. "I'll exercise vigorously right before the test to get my blood sugar down."
Answer: B.
Rationale:A balanced diet, including carbohydrates, should be consumed for 3 days before
the OGTT, followed by an 8-hour fast. Fasting too long or extreme exercise can affect test
accuracy.
A client with a Hemoglobin A1C of 6.9% is being seen in the clinic. How should the nurse
interpret this result?
A. Normal; no intervention is required
B. Consistent with a diagnosis of diabetes mellitus
C. Indicates the need for insulin therapy
D. Suggests the client is hypoglycemic
Answer: B.
Rationale:An A1C ≥ 6.5% supports a diagnosis of diabetes. It reflects average blood glucose
over 2-3 months. While insulin may be indicated, the A1C alone doesn't determine therapy
type.
A nurse is caring for an older adult client with Type 2 diabetes who has blood glucose of 712
mg/dL, is confused, and has dry mucous membranes. Which condition should the nurse
suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis (DKA)
C. Hyperglycemic Hyperosmolar State (HHS)
D. Metabolic alkalosis
, Answer: C.
Rationale:HHS is a life-threatening emergency seen in Type 2 diabetes, with severe
hyperglycemia > 600 mg/dL, neurological changes, and no significant ketosis. DKA is more
common in Type 1 and involves acidosis.
A client presents with the following values:
• Fasting blood glucose: 128 mg/dL
• 2-hour OGTT result: 210 mg/dL
• Hemoglobin A1C: 6.7%
How should the nurse interpret these findings?
A. Normal glucose regulation
B. Prediabetes
C. Impaired fasting glucose only
D. Diabetes Mellitus
Answer: D.
Rationale:All three values meet diagnostic criteria for diabetes mellitus:
• Fasting ≥ 126 mg/dL
• 2-hour OGTT ≥ 200 mg/dL
• A1C ≥ 6.5%
A client with Type 1 diabetes is pale, shaky, and diaphoretic. The nurse checks the blood
glucose and it is 58 mg/dL. What is the priority nursing action?
A. Administer IV insulin
B. Call the provider
C. Give 15g of a fast-acting carbohydrate
D. Administer glucagon IM
Answer: C.
Rationale:A blood sugar <70 mg/dL indicates hypoglycemia. The first response is the 15-15
rule: give 15g of glucose, recheck in 15 minutes. IM glucagon is reserved if patient cannot
swallow or is unconscious.
A client with a history of Type 2 diabetes reports following their diet and exercise plan.
However, their Hemoglobin A1C is 8.2%. Which action by the nurse is most appropriate?
A nurse is educating a newly diagnosed diabetic patient. Which of the following statements
made by the patient indicates understanding of Type 1 Diabetes Mellitus?
A. "If I lose weight and exercise, I may be able to stop taking insulin."
B. "My pancreas produces insulin, but not enough to meet my needs."
C. "I will need to take insulin for the rest of my life."
D. "This type of diabetes usually develops in adulthood."
Answer: C.
Rationale:Type 1 Diabetes Mellitus is characterized by the complete absence of insulin
production. These patients are insulin-dependent for life. Choices A and B describe Type 2
DM, and D is false because Type 1 typically begins in childhood.
A patient with a strong family history of diabetes presents for a wellness check. The nurse
identifies which of the following findings as the greatest modifiable risk factor for
developing Type 2 Diabetes?
A. Family history of diabetes
B. Presence of hypertension
C. Sedentary lifestyle
D. History of viral illness
Answer: C.
Rationale:While genetics and hypertension are significant, physical inactivity is a modifiable
(changeable) risk factor. Increasing activity can reduce insulin resistance and delay onset of
Type 2 DM.
A nurse is reviewing the difference between Type 1 and Type 2 Diabetes Mellitus. Which of
the following correctly explains a pathophysiological difference?
A. Type 1 involves insulin resistance; Type 2 is complete beta-cell destruction.
B. Type 1 patients may still produce some insulin in the early stages.
C. Type 2 is associated with autoimmune beta-cell destruction.
D. Type 2 involves insulin resistance and relative insulin deficiency.
,Answer: D.
Rationale:Type 2 DM is characterized by insulin resistance and a relative lack of insulin.
Type 1 involves autoimmune destruction of beta cells. A and C are reversed, and B is
incorrect.
The nurse is caring for a client with newly diagnosed Type 2 Diabetes. Which intervention is
appropriate for initial management?
A. Begin basal-bolus insulin therapy immediately
B. Educate about carbohydrate counting and administer regular insulin
C. Encourage lifestyle changes and start oral hypoglycemic agents
D. Administer glucagon intramuscularly once daily
Answer: C.
Rationale:Initial treatment for Type 2 DM often includes diet, exercise, and oral medications
such as metformin. Insulin is usually reserved for later stages or severe cases. Glucagon is
used in hypoglycemia, not daily treatment.
A nurse is reviewing lab results of a patient with suspected diabetes. Which finding would
support a diagnosis of diabetes mellitus?
A. Hemoglobin A1c of 5.9%
B. Fasting blood glucose of 118 mg/dL
C. Random plasma glucose of 210 mg/dL with polyuria
D. 2-hour oral glucose tolerance test result of 135 mg/dL
Answer: C.
Rationale:A random plasma glucose ≥200 mg/dL with symptoms (e.g., polyuria) is diagnostic.
A1c of 5.9% and fasting glucose of 118 mg/dL are pre-diabetic, not diagnostic. OGTT of 135
is also in the prediabetic range.
A nurse is preparing a client for a fasting blood glucose test. Which of the following
instructions is most appropriate?
A. "You may eat a light meal up to 4 hours before the test."
B. "Drink a sugary drink 2 hours before the blood draw."
C. "Avoid food and drink, except water, for 8 hours before the test."
D. "Take your oral antidiabetic medication the morning of the test."
,Answer: C.
Rationale:Fasting blood glucose requires an 8-hour fast, with only water allowed.
Antidiabetic meds are typically held until after the blood draw to avoid false low results.
Which of the following statements by a client indicates correct understanding of the oral
glucose tolerance test?
A. "I'll fast for 24 hours before drinking the glucose solution."
B. "I'll eat mostly carbs for 3 days before the test, then fast for 8 hours."
C. "I need to avoid all carbs for 3 days before the test."
D. "I'll exercise vigorously right before the test to get my blood sugar down."
Answer: B.
Rationale:A balanced diet, including carbohydrates, should be consumed for 3 days before
the OGTT, followed by an 8-hour fast. Fasting too long or extreme exercise can affect test
accuracy.
A client with a Hemoglobin A1C of 6.9% is being seen in the clinic. How should the nurse
interpret this result?
A. Normal; no intervention is required
B. Consistent with a diagnosis of diabetes mellitus
C. Indicates the need for insulin therapy
D. Suggests the client is hypoglycemic
Answer: B.
Rationale:An A1C ≥ 6.5% supports a diagnosis of diabetes. It reflects average blood glucose
over 2-3 months. While insulin may be indicated, the A1C alone doesn't determine therapy
type.
A nurse is caring for an older adult client with Type 2 diabetes who has blood glucose of 712
mg/dL, is confused, and has dry mucous membranes. Which condition should the nurse
suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis (DKA)
C. Hyperglycemic Hyperosmolar State (HHS)
D. Metabolic alkalosis
, Answer: C.
Rationale:HHS is a life-threatening emergency seen in Type 2 diabetes, with severe
hyperglycemia > 600 mg/dL, neurological changes, and no significant ketosis. DKA is more
common in Type 1 and involves acidosis.
A client presents with the following values:
• Fasting blood glucose: 128 mg/dL
• 2-hour OGTT result: 210 mg/dL
• Hemoglobin A1C: 6.7%
How should the nurse interpret these findings?
A. Normal glucose regulation
B. Prediabetes
C. Impaired fasting glucose only
D. Diabetes Mellitus
Answer: D.
Rationale:All three values meet diagnostic criteria for diabetes mellitus:
• Fasting ≥ 126 mg/dL
• 2-hour OGTT ≥ 200 mg/dL
• A1C ≥ 6.5%
A client with Type 1 diabetes is pale, shaky, and diaphoretic. The nurse checks the blood
glucose and it is 58 mg/dL. What is the priority nursing action?
A. Administer IV insulin
B. Call the provider
C. Give 15g of a fast-acting carbohydrate
D. Administer glucagon IM
Answer: C.
Rationale:A blood sugar <70 mg/dL indicates hypoglycemia. The first response is the 15-15
rule: give 15g of glucose, recheck in 15 minutes. IM glucagon is reserved if patient cannot
swallow or is unconscious.
A client with a history of Type 2 diabetes reports following their diet and exercise plan.
However, their Hemoglobin A1C is 8.2%. Which action by the nurse is most appropriate?
