NCLEX RN Diabetes Mellitus Nursing Test
Bank
(QUESTIONS AND CORRECT ANSWERS)
1. A patient has diabetes type 1 and receives insulin for glycemic control.
She tells the nurse that she likes to have a glass of wine with dinner. What
will the best plan of the nurse for client education include?
A. The alcohol could cause pancreatic disease.
B. The alcohol could cause serious liver disease.
C. The alcohol could predispose you to hypoglycemia.
D. The alcohol could predispose you to hyperglycemia.
Correct Answer: C. The alcohol could predispose you to
hypoglycemia.
Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the
client. When the client drinks alcohol, the alcohol can inhibit the liver’s
ability to release glucose into the blood. This can be particularly significant
for people on stronger medication such as insulin because it can mean
that the liver is not able to release enough glycogen to keep the blood
glucose levels from going too low under the influence of insulin in the
body.
Option A: Alcohol can cause pancreatic disease, but the client’s
pancreas is not producing any insulin currently. Alcohol abuse is a well-
recognized association of both acute and chronic pancreatitis, with
repeated attacks of alcohol-induced acute pancreatic necroinflammation
leading to chronic disease. The risk of developing pancreatitis increases
with increased consumption of alcohol.
Option B: Alcohol can cause liver disease, but the more immediate
concern is hypoglycemia. Moderate amounts of alcohol may cause
blood sugar to rise, excess alcohol can actually decrease your blood
sugar level – which can be dangerous for people with T1D.
Option D: People with T1D should only drink while eating food. Beer
and sweet wine contain carbohydrates and may raise blood sugar.
People may overeat when drinking alcohol which also can increase your
BG.
2. A doctor orders insulin lispro (Humalog) 10 units for Alicia, a client with
diabetes mellitus. When will the nurse administer this medication?
A. When the client is eating
B. Thirty minutes before meals
C. Fifteen minutes before meals
D. When the meal trays arrive on the floor
ZackRN65
,Correct Answer: A. When the client is eating
The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it
must be given when the client is eating to prevent hypoglycemia. Insulin
lispro is a new type of insulin. It starts working sooner than other insulin
types. It also reaches peak activity faster and goes away sooner.
Option B: If taking Regular insulin or longer-acting insulin, the client
should generally take it 15 to 30 minutes before a meal. Short-acting,
such as Regular (R) insulin, starts working within 30 minutes and lasts
about 5 to 8 hours.
Option C: Each type of insulin works at a different speed and lasts for a
different length of time. Quick-acting, such as insulin lispro (Humalog),
begins to work very quickly (5 to 15 minutes) and lasts for 3 to 4 hours.
Option D: It must be given when the client is eating, not when the
meal trays arrive on the floor. Rapid-acting insulin analogs should be
injected within 15 min before a meal or immediately after a meal. The
most commonly recommended interval between injection of short-
acting (regular) insulin and a meal is 30 min.
3. Nurse Matt makes a home visit to the client with diabetes mellitus.
During the visit, Nurse Matt notes the client’s additional insulin vials are
not refrigerated. What is the best action by the nurse at this time?
A. Instruct the client to label each vial with the date when opened.
B. Tell the client there is no need to keep additional vials.
C. Have the client place the insulin vials in the refrigerator.
D. Have the client discard the vials.
Correct Answer: C. Have the client place the insulin vials in the
refrigerator.
Vials not in use should be refrigerated to preserve drug potency. Vials of
insulin not in use should be refrigerated. Extreme temperatures (<36 or
>86°F, <2 or >30°C) and excess agitation should be avoided to prevent
loss of potency, clumping, frosting, or precipitation.
Option A: Writing the date of opening on the vial is good practice, but
does not address the need to refrigerate additional vials. Specific
storage guidelines provided by the manufacturer should be followed.
Insulin in use may be kept at room temperature to limit local irritation at
the injection site, which may occur when cold insulin is used.
Option B: The client should always have additional vials of insulin
available. The patient should always have available a spare bottle of
each type of insulin used. Although an expiration date is stamped on
each vial of insulin, a loss in potency may occur after the bottle has
been in use for >1 month, especially if it was stored at room
temperature.
Option D: There is no need to discard the vials. If uncertain about the
potency of a vial of insulin, the individual should replace the vial in
question with another of the same type. The person administering
insulin should inspect the bottle before each use for changes (i.e.,
ZackRN65
, clumping, frosting, precipitation, or change in clarity or color) that may
signify a loss in potency.
4. During the morning rounds, Nurse AJ accompanied the physician in
every patient’s room. The physician writes orders for the client with
diabetes mellitus. Which order would the nurse validate with the
physician?
A. Use Humalog insulin for sliding scale coverage.
B. Metformin (Glucophage) 1000 mg per day in divided doses.
C. Administer regular insulin 30 minutes prior to meals.
D. Lantus insulin 20U BID.
Correct Answer: D. Lantus insulin 20U BID.
Lantus insulin is usually prescribed once a day so an order for BID dosing
should be validated with the physician. Lantus is designed to give a steady
level of insulin over 24 hours, even when you are not eating such as
between meals and overnight. This helps keep blood glucose levels
consistent during the day and at night.
Option A: Humalog insulin can be prescribed for sliding scale coverage.
The use of Humalog includes correcting the high blood sugar levels just
before mealtime. For this aspect, a sliding scale is used to identify the
needed amount of insulin that the patients must take.
Option B: Metformin (Glucophage) is often prescribed in divided doses
of 1000 mg per day. Metformin is an oral medication typically dosed
from 500 to 2550 mg per day and administered with a meal to decrease
GI upset. The daily dose is often titrated weekly in increments of 500
mg or 850 mg to reduce this risk.
Option C: Regular insulin is administered 30 minutes before meals.
Insulin, regular when administered subcutaneously, should be injected
30 to 40 minutes before each meal. Avoid cold injections. The injection
is in the buttocks, thighs, arms, or abdomen; it is necessary to rotate
injection sites to avoid lipodystrophy.
5. Gary has diabetes type 2. Nurse Martha has taught him about the
illness and evaluates learning has occurred when the client makes which
statement?
A. "My cells have increased their receptors, but there is enough insulin."
B. "My peripheral cells have increased sensitivity to insulin."
C. "My beta cells cannot produce enough insulin for my cells."
D. "My cells cannot use the insulin my pancreas makes."
Correct Answer: D. “My cells cannot use the insulin my pancreas
makes.”
ZackRN65
Bank
(QUESTIONS AND CORRECT ANSWERS)
1. A patient has diabetes type 1 and receives insulin for glycemic control.
She tells the nurse that she likes to have a glass of wine with dinner. What
will the best plan of the nurse for client education include?
A. The alcohol could cause pancreatic disease.
B. The alcohol could cause serious liver disease.
C. The alcohol could predispose you to hypoglycemia.
D. The alcohol could predispose you to hyperglycemia.
Correct Answer: C. The alcohol could predispose you to
hypoglycemia.
Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the
client. When the client drinks alcohol, the alcohol can inhibit the liver’s
ability to release glucose into the blood. This can be particularly significant
for people on stronger medication such as insulin because it can mean
that the liver is not able to release enough glycogen to keep the blood
glucose levels from going too low under the influence of insulin in the
body.
Option A: Alcohol can cause pancreatic disease, but the client’s
pancreas is not producing any insulin currently. Alcohol abuse is a well-
recognized association of both acute and chronic pancreatitis, with
repeated attacks of alcohol-induced acute pancreatic necroinflammation
leading to chronic disease. The risk of developing pancreatitis increases
with increased consumption of alcohol.
Option B: Alcohol can cause liver disease, but the more immediate
concern is hypoglycemia. Moderate amounts of alcohol may cause
blood sugar to rise, excess alcohol can actually decrease your blood
sugar level – which can be dangerous for people with T1D.
Option D: People with T1D should only drink while eating food. Beer
and sweet wine contain carbohydrates and may raise blood sugar.
People may overeat when drinking alcohol which also can increase your
BG.
2. A doctor orders insulin lispro (Humalog) 10 units for Alicia, a client with
diabetes mellitus. When will the nurse administer this medication?
A. When the client is eating
B. Thirty minutes before meals
C. Fifteen minutes before meals
D. When the meal trays arrive on the floor
ZackRN65
,Correct Answer: A. When the client is eating
The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it
must be given when the client is eating to prevent hypoglycemia. Insulin
lispro is a new type of insulin. It starts working sooner than other insulin
types. It also reaches peak activity faster and goes away sooner.
Option B: If taking Regular insulin or longer-acting insulin, the client
should generally take it 15 to 30 minutes before a meal. Short-acting,
such as Regular (R) insulin, starts working within 30 minutes and lasts
about 5 to 8 hours.
Option C: Each type of insulin works at a different speed and lasts for a
different length of time. Quick-acting, such as insulin lispro (Humalog),
begins to work very quickly (5 to 15 minutes) and lasts for 3 to 4 hours.
Option D: It must be given when the client is eating, not when the
meal trays arrive on the floor. Rapid-acting insulin analogs should be
injected within 15 min before a meal or immediately after a meal. The
most commonly recommended interval between injection of short-
acting (regular) insulin and a meal is 30 min.
3. Nurse Matt makes a home visit to the client with diabetes mellitus.
During the visit, Nurse Matt notes the client’s additional insulin vials are
not refrigerated. What is the best action by the nurse at this time?
A. Instruct the client to label each vial with the date when opened.
B. Tell the client there is no need to keep additional vials.
C. Have the client place the insulin vials in the refrigerator.
D. Have the client discard the vials.
Correct Answer: C. Have the client place the insulin vials in the
refrigerator.
Vials not in use should be refrigerated to preserve drug potency. Vials of
insulin not in use should be refrigerated. Extreme temperatures (<36 or
>86°F, <2 or >30°C) and excess agitation should be avoided to prevent
loss of potency, clumping, frosting, or precipitation.
Option A: Writing the date of opening on the vial is good practice, but
does not address the need to refrigerate additional vials. Specific
storage guidelines provided by the manufacturer should be followed.
Insulin in use may be kept at room temperature to limit local irritation at
the injection site, which may occur when cold insulin is used.
Option B: The client should always have additional vials of insulin
available. The patient should always have available a spare bottle of
each type of insulin used. Although an expiration date is stamped on
each vial of insulin, a loss in potency may occur after the bottle has
been in use for >1 month, especially if it was stored at room
temperature.
Option D: There is no need to discard the vials. If uncertain about the
potency of a vial of insulin, the individual should replace the vial in
question with another of the same type. The person administering
insulin should inspect the bottle before each use for changes (i.e.,
ZackRN65
, clumping, frosting, precipitation, or change in clarity or color) that may
signify a loss in potency.
4. During the morning rounds, Nurse AJ accompanied the physician in
every patient’s room. The physician writes orders for the client with
diabetes mellitus. Which order would the nurse validate with the
physician?
A. Use Humalog insulin for sliding scale coverage.
B. Metformin (Glucophage) 1000 mg per day in divided doses.
C. Administer regular insulin 30 minutes prior to meals.
D. Lantus insulin 20U BID.
Correct Answer: D. Lantus insulin 20U BID.
Lantus insulin is usually prescribed once a day so an order for BID dosing
should be validated with the physician. Lantus is designed to give a steady
level of insulin over 24 hours, even when you are not eating such as
between meals and overnight. This helps keep blood glucose levels
consistent during the day and at night.
Option A: Humalog insulin can be prescribed for sliding scale coverage.
The use of Humalog includes correcting the high blood sugar levels just
before mealtime. For this aspect, a sliding scale is used to identify the
needed amount of insulin that the patients must take.
Option B: Metformin (Glucophage) is often prescribed in divided doses
of 1000 mg per day. Metformin is an oral medication typically dosed
from 500 to 2550 mg per day and administered with a meal to decrease
GI upset. The daily dose is often titrated weekly in increments of 500
mg or 850 mg to reduce this risk.
Option C: Regular insulin is administered 30 minutes before meals.
Insulin, regular when administered subcutaneously, should be injected
30 to 40 minutes before each meal. Avoid cold injections. The injection
is in the buttocks, thighs, arms, or abdomen; it is necessary to rotate
injection sites to avoid lipodystrophy.
5. Gary has diabetes type 2. Nurse Martha has taught him about the
illness and evaluates learning has occurred when the client makes which
statement?
A. "My cells have increased their receptors, but there is enough insulin."
B. "My peripheral cells have increased sensitivity to insulin."
C. "My beta cells cannot produce enough insulin for my cells."
D. "My cells cannot use the insulin my pancreas makes."
Correct Answer: D. “My cells cannot use the insulin my pancreas
makes.”
ZackRN65
