Week 8: Pharmacology of Diabetes Mellitus

Question 1

A patient newly diagnosed with Type 1 Diabetes Mellitus (T1DM) asks why they need insulin injections. The nurse’s best response is:
A. “Insulin will help your pancreas produce more insulin.”
B. “Insulin is required because your body no longer produces it.”
C. “Insulin will cure your diabetes.”
D. “Insulin is used to prevent complications of diabetes.”

Answer 1

Correct Answer: B
Rationale: T1DM is characterized by the autoimmune destruction of beta cells in the pancreas, resulting in the inability to produce insulin.
WRONG ANSWERS:
A: Insulin does not stimulate the pancreas to produce insulin; this occurs in T2DM therapies.

C: There is no cure for diabetes; insulin manages blood glucose levels.

D: While insulin prevents complications, the primary reason for its use in T1DM is the lack of endogenous insulin production.

Question 2

Which of the following symptoms are most commonly associated with hyperglycemia?
A. Tremors, sweating, irritability
B. Polyuria, polydipsia, polyphagia
C. Dizziness, headache, confusion
D. Weight gain, fatigue, bradycardia

Answer 2

Correct Answer: B
Rationale: The “3 P’s” (polyuria, polydipsia, and polyphagia) are hallmark symptoms of hyperglycemia.

Rationale for Incorrect Answers:

A: These symptoms are more commonly associated with hypoglycemia due to SNS activation.

C: While confusion and headache can occur with hyperglycemia, they are not defining symptoms.

D: Weight gain and fatigue are often seen with T2DM but are not specific to hyperglycemia.

Question 3

A nurse is teaching a patient about insulin storage. Which statement by the patient indicates a need for further education?
A. “I will store unopened insulin vials in the refrigerator.”
B. “Once opened, I can keep insulin at room temperature for up to a month.”
C. “I can freeze insulin to prolong its shelf life.”
D. “I should always check the expiration date before using insulin.”

Answer 3

Correct Answer: C
Rationale: Insulin should never be frozen as it can affect its efficacy.

Rationale for Incorrect Answers:

A: Storing unopened insulin in the refrigerator is correct.

B: Opened insulin can be stored at room temperature for up to a month without compromising its effectiveness.

D: Checking the expiration date is an essential practice for safe medication use.

Question 4

A patient is prescribed Metformin for Type 2 Diabetes Mellitus (T2DM). What is the primary action of this medication?
A. Stimulates the pancreas to produce more insulin
B. Inhibits glucose production in the liver
C. Increases glucose absorption in the intestines
D. Blocks insulin receptors in target cells

Answer 4

Correct Answer: B
Rationale: Metformin reduces glucose production in the liver, improves insulin sensitivity, and decreases glucose absorption in the intestines.
Rationale for Incorrect Answers:

A: Sulfonylureas and glinides stimulate insulin secretion, not Metformin.

C: Metformin decreases glucose absorption, not increases it.

D: Blocking insulin receptors would worsen hyperglycemia, not treat it.

Question 5

Which insulin is classified as long-acting and provides a duration of up to 24 hours?
A. Insulin Aspart
B. Insulin Lispro
C. Insulin Glargine
D. Regular Insulin

Answer 5

Correct Answer: C
Rationale: Insulin Glargine (e.g., Lantus) is a long-acting insulin that provides basal glucose control for up to 24 hours.
Rationale for Incorrect Answers:

A and B: Insulin Aspart and Lispro are rapid-acting insulins.

D: Regular insulin is short-acting with a duration of up to 8 hours.

Question 6

Which of the following are symptoms of hypoglycemia? Select all that apply:

A. Sweating

B. Tachycardia

C. Blurred vision

D. Polyuria

E. Dizziness

Answer 6

Correct Answers: A, B, E
Rationale: Symptoms of hypoglycemia include sweating, tachycardia, dizziness, confusion, and hunger. Polyuria is a symptom of hyperglycemia.

Question 7

A nurse is reviewing factors that can increase insulin needs. Which of the following conditions should the nurse include? Select all that apply:

A. Stress

B. Exercise

C. Infection

D. Growth spurts

E. First trimester of pregnancy

Answer 7

Correct Answers: A, C, D
Rationale: Insulin needs increase during stress, infection, and growth spurts due to higher glucose demand. Exercise and the first trimester of pregnancy often decrease insulin requirements.

Question 8

A nurse is teaching a patient about managing hypoglycemia. Which of the following are appropriate treatments for a conscious patient? Select all that apply:

A. Glucose tablets

B. IV glucose

C. Sugary soda

D. Honey

E. Glucagon injection

Answer 8

Correct Answers: A, C, D
Rationale: Conscious patients can be treated with quick-acting carbohydrates such as glucose tablets, sugary drinks, or honey. IV glucose and glucagon injections are reserved for unconscious patients.

Question 9

A patient asks about the side effects of SGLT-2 inhibitors. Which side effects should the nurse include? Select all that apply:

A. Increased urination

B. Genital infections

C. Weight gain

D. Postural hypotension

E. Retinopathy

Answer 9

Correct Answers: A, B, D
Rationale: Common side effects of SGLT-2 inhibitors include increased urination, genital infections, and postural hypotension. Weight gain is more associated with sulfonylureas.

Question 10

Which insulins can be administered via a continuous infusion pump? Select all that apply:

A. Regular insulin

B. Insulin Lispro

C. Insulin Aspart

D. Insulin Glargine

E. Insulin Degludec(tresbia)

Answer 10

Correct Answers: A, B, C
Rationale: Short-acting insulins, such as Regular, Lispro, and Aspart, are commonly used in insulin pumps for basal and bolus dosing.

Question 11

Question: Explain the importance of “tight glycemic control” in managing Type 1 Diabetes Mellitus.

Answer 11

Answer: Tight glycemic control involves maintaining blood glucose levels within a normal range to prevent both hyperglycemia and hypoglycemia. It helps reduce the risk of long-term complications such as cardiovascular disease, retinopathy, and neuropathy.

Question 12

Question: Describe the mechanism of action of Sulfonylureas in managing T2DM.

Answer 12

Answer: Sulfonylureas stimulate insulin release from pancreatic beta cells by blocking potassium channels in the cell membrane, leading to depolarization and calcium influx. This enhances insulin secretion and sensitivity.

Question 13

Question: What patient teaching points are essential for preventing lipohypertrophy in individuals using insulin injections?

Answer 13

Answer: Patients should rotate injection sites by approximately 2.5 cm within the same area to prevent repeated use of the same site, which can lead to the development of fatty lumps (lipohypertrophy) and interfere with insulin absorption.

Question 14

Question: Identify the treatment for a patient experiencing severe hypoglycemia who is unconscious.

Answer 14

Answer: Administer IV glucose or an intramuscular glucagon injection to rapidly increase blood glucose levels.

Question 15

Question: What is the role of Hemoglobin A1c (Hgb A1c) in diabetes management?

Answer 15

Answer: Hgb A1c reflects the average blood glucose levels over the past 2-3 months, helping assess long-term glycemic control. The goal for most patients with diabetes is to maintain an Hgb A1c below 7%.

Question 16

A patient with type 1 diabetes (T1DM) is experiencing hypoglycemia. Which of the following symptoms should the nurse expect to observe?

A) Bradycardia and confusion
B) Tachycardia and perspiration
C) Fever and blurred vision
D) Hypotension and weight gain
E) Polyuria and fatigue

Answer 16

Correct Answer: B) Tachycardia and perspiration
Rationale: Hypoglycemia activates the sympathetic nervous system (SNS), causing symptoms such as tachycardia, palpitations, perspiration, nervousness, and headache.

Incorrect Answers:
A) Bradycardia is not typically associated with hypoglycemia; SNS activation increases heart rate.
C) Fever and blurred vision are not primary symptoms of hypoglycemia.
D) Hypotension and weight gain are not typical symptoms of hypoglycemia.
E) Polyuria and fatigue are more associated with hyperglycemia, not hypoglycemia.

Question 17

A patient with type 2 diabetes (T2DM) is prescribed metformin (a biguanide). Which of the following is an expected side effect of this medication?

A) Weight gain and hypoglycemia
B) GI symptoms and lactic acidosis
C) Blurred vision and hyperkalemia
D) Tachycardia and fluid retention
E) Insulin resistance and polyphagia

Answer 17

Correct Answer: B) GI symptoms and lactic acidosis
Rationale: Metformin can cause gastrointestinal symptoms (e.g., nausea, diarrhea) and, in rare cases, lactic acidosis, especially in patients with kidney dysfunction.
Incorrect Answers:
A) Metformin does not typically cause weight gain or hypoglycemia.
C) Blurred vision and hyperkalemia are not side effects of metformin.
D) Tachycardia and fluid retention are not associated with metformin.
E) Insulin resistance and polyphagia are signs of T2DM but not side effects of metformin.

Question 18

A patient with type 1 diabetes asks why they need to use both basal and bolus insulin. The nurse explains that basal insulin:

A) Is given before meals to control postprandial blood sugar spikes.
B) Mimics the normal, continuous insulin secretion needed for basal metabolism.
C) Is used to treat hypoglycemia and control glucose levels during exercise.
D) Is the only insulin used for managing blood sugar in T2DM.
E) Is necessary only in children with type 1 diabetes.

Answer 18

Correct Answer: B) Mimics the normal, continuous insulin secretion needed for basal metabolism
Rationale: Basal insulin provides a continuous level of insulin to regulate glucose throughout the day and night, mimicking normal pancreatic function.
Incorrect Answers:
A) Bolus insulin is used before meals to control postprandial blood sugar spikes, not basal insulin.
C) Basal insulin does not treat hypoglycemia or control glucose levels during exercise; bolus insulin is used for mealtime adjustments.
D) Basal insulin is necessary for both T1DM and T2DM, not just T2DM.
E) Basal insulin is required for all individuals with T1DM, not only children.

Question 19

A pregnant woman diagnosed with gestational diabetes is being educated about the effects of pregnancy hormones. Which of the following best explains why gestational diabetes occurs during pregnancy?

A) Pregnancy hormones antagonize insulin, leading to insulin resistance.
B) Excess glucose produced by the fetus overwhelms maternal insulin production.
C) Cortisol levels during pregnancy increase insulin sensitivity.
D) Placental hormones enhance insulin production to support the fetus.
E) A decrease in maternal insulin secretion causes hyperglycemia.

Answer 19

Correct Answer: A) Pregnancy hormones antagonize insulin, leading to insulin resistance
Rationale: Pregnancy hormones, such as cortisol and human placental lactogen, cause insulin resistance in the mother, leading to gestational diabetes.
Incorrect Answers:
B) Glucose from the fetus does not overwhelm maternal insulin; insulin resistance leads to higher maternal blood glucose levels.
C) Cortisol actually raises blood sugar, contributing to insulin resistance.
D) Placental hormones cause insulin resistance, not increased insulin production.
E) Decreased insulin secretion is not the primary cause of gestational diabetes; insulin resistance is the main factor.

Question 20

A patient with type 2 diabetes (T2DM) asks how metformin works. The nurse responds that metformin:

A) Stimulates the pancreas to produce more insulin.
B) Increases insulin sensitivity and reduces glucose production in the liver.
C) Inhibits glucose uptake in the intestines.
D) Stimulates the kidneys to excrete excess glucose.
E) Causes weight loss and suppresses hunger.

Answer 20

Correct Answer: B) Increases insulin sensitivity and reduces glucose production in the liver
Rationale: Metformin works by increasing insulin sensitivity and decreasing hepatic glucose production, which helps lower blood glucose levels in T2DM.
Incorrect Answers:
A) Metformin does not stimulate insulin production; it works by improving insulin sensitivity.
C) Metformin does not inhibit glucose uptake in the intestines; it may reduce glucose absorption slightly.
D) Metformin does not work through the kidneys; it acts primarily on insulin sensitivity and liver glucose production.
E) Metformin may have a mild weight-lowering effect, but it does not directly suppress hunger.

Question 21

A patient with type 1 diabetes is using an insulin pump. Which of the following is a benefit of using an insulin pump?

A) The insulin pump provides a constant infusion of both basal and bolus insulin.
B) The insulin pump eliminates the need for glucose monitoring.
C) The insulin pump only administers basal insulin and requires injections for bolus doses.
D) The insulin pump can administer insulin for the treatment of hypoglycemia.
E) The insulin pump is used for patients with type 2 diabetes only.

Answer 21

Correct Answer: A) The insulin pump provides a constant infusion of both basal and bolus insulin
Rationale: Insulin pumps provide continuous basal insulin and allow for bolus doses based on carbohydrate intake, making them ideal for patients with T1DM.
Incorrect Answers:
B) Glucose monitoring is still necessary to adjust insulin doses appropriately.
C) The insulin pump administers both basal and bolus insulin, eliminating the need for injections.
D) The insulin pump is used for routine insulin delivery, not for treating hypoglycemia directly.
E) The insulin pump is primarily used for T1DM, although some T2DM patients may use it as well.

Question 22

A patient with type 1 diabetes is preparing for insulin administration and asks about the difference between basal and bolus insulin. The nurse explains that bolus insulin is used to:

A) Control blood glucose between meals and overnight.
B) Provide continuous insulin coverage throughout the day.
C) Manage blood glucose during periods of stress.
D) Control blood glucose during meals or snacks.
E) Regulate blood glucose in the absence of food intake.

Answer 22

Correct Answer:
D) Control blood glucose during meals or snacks
Rationale: Bolus insulin is used to manage postprandial blood sugar spikes by administering insulin at mealtime or when consuming carbohydrates.

Incorrect Answers:
A) Basal insulin is used for continuous glucose regulation between meals and overnight.
B) Basal insulin provides continuous coverage, not bolus insulin.
C) Stress may increase glucose production, but it’s not the primary role of bolus insulin.
E) Basal insulin controls blood glucose when food intake is not occurring.

Question 23

A patient with type 2 diabetes is prescribed sulfonylureas. Which of the following is a major side effect of sulfonylureas?

A) Hypoglycemia
B) Weight loss
C) Lactic acidosis
D) Hyperglycemia
E) Diarrhea

Answer 23

Correct Answer:
A) Hypoglycemia
Rationale: Sulfonylureas can increase insulin release from the pancreas, which may lead to hypoglycemia, especially if food intake is inadequate.

Incorrect Answers:
B) Sulfonylureas may lead to weight gain, not weight loss.
C) Lactic acidosis is more associated with metformin, not sulfonylureas.
D) Sulfonylureas help lower blood sugar, not increase it.
E) Diarrhea is a common side effect of metformin, not sulfonylureas.

Question 24

A nurse is teaching a patient with diabetes about insulin injection sites. Which of the following locations is best for insulin absorption?

A) Thigh
B) Buttocks
C) Abdomen
D) Upper arm
E) Lower back

Answer 24

Correct Answer:
C) Abdomen
Rationale: The abdomen provides the best absorption rate for insulin, as it has more subcutaneous tissue and is better perfused than other areas.

Incorrect Answers:
A) The thigh has slower absorption compared to the abdomen.
B) The buttocks have a slower absorption rate compared to the abdomen.
D) The upper arm also has slower absorption rates.
E) The lower back is not typically recommended for insulin injections.

Question 25

A patient with diabetes is prescribed a continuous glucose monitor (CGM). Which of the following is a benefit of using a CGM?

A) It can be used to replace insulin injections completely.
B) It provides real-time blood glucose readings and helps adjust insulin delivery.
C) It eliminates the need for self-monitoring blood glucose.
D) It is only effective for patients with type 2 diabetes.
E) It helps treat severe hypoglycemia episodes.

Answer 25

Correct Answer: B) It provides real-time blood glucose readings and helps adjust insulin delivery
Rationale: A CGM provides continuous glucose readings, helping patients make timely decisions about insulin administration.
Incorrect Answers:
A) A CGM does not replace insulin injections; it helps with monitoring.
C) CGM does not completely eliminate the need for fingerstick blood glucose tests.
D) CGMs are effective for both T1DM and T2DM patients.
E) CGMs do not treat hypoglycemia; they provide data to manage it.

Question 26

A patient with type 2 diabetes is using a SGLT2 inhibitor. Which of the following is a potential side effect of this medication?

A) Urinary tract infections
B) Increased appetite
C) Hypertension
D) Weight gain
E) Bradycardia

Answer 26

Correct Answer: A) Urinary tract infections
Rationale: SGLT2 inhibitors increase glucose excretion through the urine, which can increase the risk of urinary tract infections.
Incorrect Answers:
B) SGLT2 inhibitors can lead to weight loss, not increased appetite.
C) SGLT2 inhibitors may lower blood pressure, not increase it.
D) SGLT2 inhibitors are associated with weight loss, not weight gain.
E) Bradycardia is not a typical side effect of SGLT2 inhibitors.

Question 27

A nurse is educating a pregnant patient with gestational diabetes on self-management. Which of the following strategies is most important for managing gestational diabetes?

A) Avoiding all carbohydrates to reduce glucose levels.
B) Monitoring blood glucose levels as directed by the healthcare provider.
C) Increasing protein intake to prevent hyperglycemia.
D) Exercising only during pregnancy to control blood sugar.
E) Discontinuing insulin injections after delivery.

Answer 27

Correct Answer:
B) Monitoring blood glucose levels as directed by the healthcare provider
Rationale: Monitoring blood glucose regularly is critical in managing gestational diabetes to maintain optimal blood sugar levels.

Incorrect Answers:
A) Completely avoiding carbohydrates is not recommended, as it may affect the baby’s development.
C) Protein intake does not directly control blood sugar; managing carbohydrates is key.
D) Regular exercise is important throughout life, not just during pregnancy.
E) Insulin may still be needed postpartum if the patient has developed T2DM.

Question 28

A patient with diabetes is at risk for foot ulcers. The nurse should educate the patient to:

A) Soak feet in hot water daily to improve circulation.
B) Trim toenails in a straight line to prevent ingrown nails.
C) Wear tight-fitting shoes to prevent blisters.
D) Apply moisturizing cream to between toes to prevent cracking.
E) Walk barefoot to improve foot strength.

Answer 28

Correct Answer: B) Trim toenails in a straight line to prevent ingrown nails
Rationale: Trimming toenails straight across helps prevent ingrown nails and reduces the risk of infection, which can lead to ulcers.
Incorrect Answers:
A) Soaking feet in hot water can cause burns and dry the skin.
C) Tight-fitting shoes increase the risk of blisters and foot ulcers.
D) Moisturizing between toes can increase the risk of fungal infections.
E) Walking barefoot can increase the risk of injury and infection.

Question 29

A patient with diabetes is experiencing neuropathy. The nurse should recommend which of the following treatments?

A) Application of heating pads to reduce pain.
B) Taking antihistamines for itching.
C) Daily foot inspection to check for injury or infection.
D) Avoiding exercise to prevent injury.
E) Applying ice to numb areas of discomfort.

Answer 29

Correct Answer: C) Daily foot inspection to check for injury or infection
Rationale: Neuropathy increases the risk of unnoticed injuries and infections. Daily foot inspections are essential to catch potential problems early.
Incorrect Answers:
A) Heat can increase inflammation and should be avoided in neuropathy.
B) Antihistamines do not treat neuropathic pain.
D) Exercise is important for blood flow and circulation.
E) Ice can numb the area but is not appropriate for treating neuropathy pain.

Question 30

A patient with diabetes asks about dietary changes to manage their condition. Which of the following should the nurse recommend?

A) Reducing protein intake to minimize kidney strain.
B) Increasing carbohydrate intake for stable blood sugar.
C) Eating smaller, more frequent meals to prevent large glucose spikes.
D) Avoiding all sugary foods, even fruits.
E) Following a high-fat diet to balance insulin needs.

Answer 30

Correct Answer: C) Eating smaller, more frequent meals to prevent large glucose spikes
Rationale: Smaller meals can help maintain more stable blood glucose levels and prevent large spikes or drops.
Incorrect Answers:
A) Reducing protein intake is not typically necessary unless kidney disease is present.
B) Carbohydrate intake should be balanced, not excessively increased.
D) Fruits provide essential nutrients and should not be avoided completely; portion control is key.
E) A high-fat diet is not ideal for diabetes management and may worsen heart health.

Question 31

1. Question:
   What is the primary hormone that regulates blood glucose levels in the body?

Answer 31

Answer:
Insulin

Rationale:
Insulin is produced by the pancreas and helps lower blood glucose levels by facilitating the uptake of glucose into cells for energy.

Question 32

Question:
What is the common term for blood sugar that is too low?

Answer 32

Answer:
Hypoglycemia

Rationale:
Hypoglycemia occurs when blood glucose levels drop below the normal range, leading to symptoms like shakiness, confusion, and sweating.

Question 33

What is the medical term for high blood sugar?

Answer 33

Answer:
Hyperglycemia

Rationale:
Hyperglycemia refers to elevated blood glucose levels, often seen in uncontrolled diabetes, which can lead to long-term complications if not managed.

Question 34

List one long-term complication of poorly managed diabetes.

Answer 34

Answer:
Diabetic Retinopathy
or
Kidney Disease
or
Neuropathy

Rationale:
Poorly controlled diabetes can lead to complications such as diabetic retinopathy (damage to the eyes), kidney disease, or neuropathy (nerve damage), among others.

Question 35

What is the key difference between Type 1 and Type 2 diabetes?

Answer 35

Answer:
Type 1: Insulin deficiency
Type 2: Insulin resistance

Rationale:
In Type 1 diabetes, the pancreas produces little to no insulin, while in Type 2 diabetes, the body becomes resistant to insulin, often leading to inadequate insulin function.

Question 36

What is the primary treatment for Type 1 diabetes?

Answer 36

Answer:
Insulin

Rationale:
Type 1 diabetes is characterized by the body’s inability to produce insulin, so insulin therapy is necessary for managing blood glucose levels.

Question 37

What is the most common cause of diabetic ketoacidosis (DKA)?

Answer 37

Answer:
Insulin deficiency

Rationale:
In DKA, a severe lack of insulin causes the body to break down fat for energy, producing ketones that can lead to acidosis.

Question 38

What is the normal range for fasting blood glucose levels in a healthy adult?

Answer 38

Answer:
70-99 mg/dL

Rationale:
Normal fasting blood glucose levels typically range from 70 to 99 mg/dL. Higher levels may indicate prediabetes or diabetes.

Question 39

What is the role of a registered dietitian in managing diabetes?

Answer 39

Answer: Nutrition planning

Rationale:
A registered dietitian helps individuals with diabetes create personalized nutrition plans to control blood sugar levels and prevent complications.

Question 40

What is the medical term for a condition where the body has high levels of ketones in the blood?

Answer 40

Answer:
Ketoacidosis

Rationale:
Ketoacidosis occurs when high levels of ketones, produced by the breakdown of fat for energy, accumulate in the blood, leading to acidosis, which is dangerous if untreated.

Question 41

A patient with Type 1 diabetes mellitus is prescribed rapid-acting insulin. Which statement best explains the pharmacological action of this type of insulin?
A. It has a delayed onset, making it ideal for basal control.
B. It has an onset of 15–30 minutes, making it effective for managing post-prandial glucose spikes.
C. It forms microprecipitates in subcutaneous tissue to provide extended release.
D. It binds to plasma albumin for a dose-dependent duration of up to 24 hours.

Answer 41

Answer: B
Rationale: Rapid-acting insulin, such as insulin lispro or aspart, has an onset of 15–30 minutes and is used for post-prandial glucose control.

Question 42

Which receptor activity stimulates insulin release from the pancreas?
A. Activation of alpha-adrenergic receptors
B. Activation of beta-2 adrenergic receptors
C. Inhibition of beta-1 adrenergic receptors
D. Inhibition of dopamine receptors

Answer 42

Answer: B
Rationale: Beta-2 adrenergic receptor activation stimulates insulin release, whereas alpha receptor activation inhibits insulin release.

Question 43

A nurse is teaching a patient about the difference between short-acting and intermediate-acting insulin. Which statement by the patient indicates understanding?
A. “Short-acting insulin, like Humulin R, provides steady basal control throughout the day.”
B. “Intermediate-acting insulin, like NPH, peaks at 4–6 hours and helps with basal glucose control.”
C. “Short-acting insulin is cloudy and must be rolled before injection.”
D. “Intermediate-acting insulin is ideal for mealtime glucose spikes.

Answer 43

Answer: B
Rationale: NPH insulin is intermediate-acting, peaks at 4–6 hours, and is used for basal control. Short-acting insulin is clear and used for mealtime glucose management.

Question 44

Which of the following is the most appropriate response to a patient experiencing hypoglycemia with blood glucose <4 mmol/L?
A. Administer 50 mL of 50% dextrose IV immediately.
B. Encourage the patient to engage in light exercise to raise blood glucose levels.
C. Provide 15 g of fast-acting carbohydrates, such as orange juice or glucose tablets.
D. Inject a dose of regular insulin to stabilize glucose levels.

Answer 44

Answer: C
Rationale: Hypoglycemia is treated with 15 g of fast-acting carbohydrates to quickly elevate blood glucose. Severe cases may require IV dextrose or glucagon.

Question 45

A patient on a continuous subcutaneous insulin infusion (CSII) asks how the pump works. What is the nurse’s best response?
A. “The pump uses intermediate-acting insulin to provide continuous basal and bolus coverage.”
B. “The pump delivers rapid-acting insulin continuously for basal needs and can be adjusted for bolus doses at mealtimes.”
C. “The pump administers long-acting insulin at set intervals throughout the day.”
D. “The pump alternates between rapid- and long-acting insulin depending on glucose readings.”

Answer 45

Answer: B
Rationale: CSII devices use rapid-acting insulin to provide a continuous basal rate and allow for bolus doses based on carbohydrate intake or glucose readings.

Question 46

Which insulin delivery method poses the highest risk of lipohypertrophy if injection sites are not rotated properly?
A. Continuous subcutaneous insulin infusion (CSII)
B. Insulin pen
C. Subcutaneous injections using syringes
D. Intravenous insulin administration

Answer 46

Answer: C
Rationale: Repeated subcutaneous injections into the same site can lead to lipohypertrophy, interfering with insulin absorption.

Question 47

What is the primary difference between regular insulin (Humulin R) and rapid-acting insulin analogs (e.g., Lispro)?
A. Regular insulin forms aggregates at the injection site, delaying absorption.
B. Rapid-acting insulin is used only for basal glucose control.
C. Regular insulin has a shorter duration of action compared to rapid-acting insulin.
D. Rapid-acting insulin is absorbed more slowly than regular insulin.

Answer 47

Answer: A
Rationale: Regular insulin forms aggregates at the injection site, which delays absorption and prolongs onset compared to rapid-acting insulin.

Question 48

A nurse is preparing to administer glargine insulin (Lantus). Which statement is accurate about its pharmacokinetics?
A. “Glargine insulin peaks at 1–3 hours and lasts for up to 8 hours.”
B. “Glargine insulin has no peak and provides steady basal control for up to 24 hours.”
C. “Glargine insulin is mixed with rapid-acting insulin for bolus coverage.”
D. “Glargine insulin must be rolled or shaken before administration due to its suspension form.”

Answer 48

Answer: B
Rationale: Glargine insulin has no peak and provides steady basal control for up to 24 hours. It is a clear solution and does not require mixing.

Question 49

Which receptor activation stimulates the release of insulin from the pancreas?
A. Alpha-adrenergic receptors
B. Beta-2 adrenergic receptors
C. Beta-1 adrenergic receptors
D. Dopamine receptors

Answer 49

Correct Answer: B
Rationale: Activation of beta-2 adrenergic receptors in the pancreas stimulates insulin release, while alpha-adrenergic activation inhibits it.

Question 50

A patient with Type 1 Diabetes Mellitus is prescribed rapid-acting insulin lispro. When should the nurse advise the patient to administer this insulin?
A. Immediately after eating
B. 30 minutes before eating
C. At bedtime
D. 15 minutes before eating

Answer 50

Correct Answer: D
Rationale: Rapid-acting insulins like lispro should be administered 15 minutes before a meal to control post-prandial glucose levels effectively.

Question 51

A patient taking metformin (a biguanide) for Type 2 Diabetes reports symptoms of muscle pain and fatigue. The nurse suspects which rare but serious side effect?
A. Hypoglycemia
B. Lactic acidosis
C. Ketoacidosis
D. Hyperosmolar hyperglycemic state

Answer 51

Correct Answer: B
Rationale: Metformin can cause lactic acidosis, a rare but potentially life-threatening condition characterized by muscle pain, fatigue, and increased lactate levels.

Question 52

Which insulin administration method provides both basal and bolus insulin coverage for patients with Type 1 Diabetes Mellitus?
A. Twice-daily premixed insulin
B. Continuous subcutaneous insulin infusion (CSII)
C. Intermediate-acting insulin (NPH)
D. Inhaled regular insulin

Answer 52

Correct Answer: B
Rationale: CSII (portable insulin pumps) uses rapid-acting insulin to provide a continuous basal rate and bolus doses at mealtimes for tight glycemic control.

Question 53

What is the primary mechanism of action of sulfonylureas in managing Type 2 Diabetes Mellitus?
A. Decrease glucose absorption in the intestine
B. Increase insulin sensitivity in peripheral tissues
C. Stimulate insulin secretion from pancreatic beta cells
D. Inhibit gluconeogenesis in the liver

Answer 53

Correct Answer: C
Rationale: Sulfonylureas stimulate the pancreas to release insulin by acting on beta cells.

Question 54

A patient using long-acting insulin glargine asks how it works to control blood sugar levels. What is the nurse’s best response?
A. “It rapidly lowers blood glucose levels after meals.”
B. “It provides a slow and steady release of insulin over 24 hours.”
C. “It is absorbed quickly and peaks in 1-3 hours.”
D. “It reduces insulin resistance in peripheral tissues.”

Answer 54

Correct Answer: B
Rationale: Long-acting insulins like glargine provide a slow and steady release over 24 hours to mimic basal insulin.

Question 55

Which medication for diabetes is most likely to cause hypoglycemia when taken without food?
A. Metformin
B. Glipizide
C. Pioglitazone
D. Sitagliptin

Answer 55

Correct Answer: B
Rationale: Sulfonylureas like glipizide stimulate insulin release, which can lead to hypoglycemia if not accompanied by food.

Question 56

A nurse is preparing to administer an intermediate-acting insulin (NPH). Which statement about this type of insulin is accurate?
A. It is clear and should not be mixed with other insulins.
B. It has a peak effect of 4-6 hours and provides basal control.
C. It is given immediately before meals to manage post-prandial glucose spikes.
D. It has no significant peak and lasts 24 hours.

Answer 56

Correct Answer: B
Rationale: NPH is an intermediate-acting insulin with a peak effect at 4-6 hours and provides basal glucose control when administered 2-3 times daily.

Question 57

Which of the following is a contraindication for prescribing metformin?
A. BMI greater than 30
B. Type 2 Diabetes diagnosed less than 6 months ago
C. Estimated Glomerular Filtration Rate (eGFR) < 30 mL/min
D. Patient taking a sulfonylurea concurrently

Answer 57

Correct Answer: C
Rationale: Metformin is contraindicated in patients with severe renal impairment (eGFR < 30 mL/min) due to the increased risk of lactic acidosis.

Question 58

What is the primary action of DPP-4 inhibitors like sitagliptin in managing Type 2 Diabetes Mellitus?
A. Stimulating insulin secretion from beta cells
B. Slowing the inactivation of incretin hormones
C. Reducing insulin resistance in skeletal muscle
D. Increasing glucose excretion in the urine

Answer 58

Correct Answer: B
Rationale: DPP-4 inhibitors prolong the action of incretin hormones, which stimulate insulin release and suppress glucagon secretion.

Question 59

A patient newly diagnosed with Type 2 Diabetes Mellitus is prescribed acarbose. What key teaching point should the nurse include regarding this medication?
A. “Take this medication with your first bite of food.”
B. “This medication can cause weight gain, so monitor your diet carefully.”
C. “If you experience low blood sugar, treat it with a regular soda or candy.”
D. “This medication works by increasing insulin secretion from your pancreas.

Answer 59

Correct Answer: A
Rationale: Acarbose, an alpha-glucosidase inhibitor, delays carbohydrate absorption in the intestine and should be taken with the first bite of food for maximum effect.

Question 60

A patient on insulin therapy develops tremors, diaphoresis, and confusion. What is the nurse’s priority action?
A. Administer a dose of glucagon.
B. Check the patient’s blood glucose level.
C. Call the healthcare provider immediately.
D. Give the patient 10 units of rapid-acting insulin.

Answer 60

Correct Answer: B
Rationale: Symptoms suggest hypoglycemia. The nurse should first confirm it by checking blood glucose before taking further action.

Question 61

A nurse is educating a patient about the use of an insulin pen for daily injections. Which statement by the patient indicates a need for further teaching?
A. “I will store the insulin pen in the refrigerator when not in use.”
B. “I will prime the pen before each injection to remove air bubbles.”
C. “I will inject the insulin into the same site every day to minimize pain.”
D. “I will hold the pen in place for 5-10 seconds after injecting the insulin.

Answer 61

Correct Answer: C
Rationale: Rotating injection sites is essential to prevent lipodystrophy, a complication of repeated injections in the same area.

Question 62

A patient with Type 2 Diabetes is prescribed canagliflozin(SGLT2 inhibitor) Which side effect should the nurse teach the patient to monitor for?
A. Persistent cough
B. Frequent urinary tract infections
C. Severe hypoglycemia
D. Weight gain

Answer 62

Correct Answer: B
Rationale: Canagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, increases glucose excretion in the urine, which can predispose patients to urinary tract infections.

Question 63

The nurse is educating a patient with diabetes about medications that can cause hypoglycemia when combined with insulin. Which of the following medications should the nurse include?
A. Glucocorticoids
B. Sulfonylureas
C. Sympathomimetics
D. Beta blockers

Answer 63

Correct Answer: B
Rationale: Sulfonylureas stimulate insulin secretion, increasing the risk of hypoglycemia when combined with insulin

Question 64

A patient with diabetes is taking insulin and starts therapy with glucocorticoids. What is the most likely effect on the patient’s blood glucose levels?
A. The patient’s blood glucose levels will remain stable.
B. The patient’s blood glucose levels will decrease.
C. The patient’s blood glucose levels will increase.
D. The glucocorticoids will have no effect on blood glucose levels.

Answer 64

Correct Answer: C
Rationale: Glucocorticoids can cause hyperglycemia by promoting gluconeogenesis and counteracting the effects of insulin.

Question 65

A patient on insulin therapy is also prescribed a beta blocker for hypertension. What teaching point should the nurse emphasize regarding this combination of medications?
A. “Beta blockers will enhance the effect of insulin, so your dose may need to be reduced.”
B. “Beta blockers may mask the symptoms of hypoglycemia, such as tachycardia and tremors.”
C. “Beta blockers increase insulin clearance, so your blood sugar may remain low.”
D. “Beta blockers prevent glycogen storage, increasing the risk of hyperglycemia.”

Answer 65

Correct Answer: B
Rationale: Beta blockers can mask symptoms of hypoglycemia like tachycardia and tremors, which may delay the recognition of low blood sugar.

Question 66

Question 4
The nurse is caring for a patient on insulin who reports drinking excessive amounts of alcohol. What should the nurse consider when assessing this patient’s risk of hypoglycemia?
A. Alcohol can increase glycogenolysis, raising blood sugar levels.
B. Alcohol can increase insulin clearance, causing hyperglycemia.
C. Alcohol impairs glycogenolysis, increasing the risk of hypoglycemia.
D. Alcohol has no significant effect on insulin or blood sugar.

Answer 66

Correct Answer: C
Rationale: Excessive alcohol use can impair glycogenolysis, the body’s mechanism for raising blood sugar, increasing the risk of hypoglycemia in patients on insulin.

Question 67

A patient with type 1 diabetes is prescribed insulin therapy. Which of the following medications, if taken concurrently, is most likely to counteract the effects of insulin?
A. Sulfonylureas
B. Glinides
C. Glucocorticoids
D. Alcohol

Answer 67

Correct Answer: C
Rationale: Glucocorticoids can cause hyperglycemia by promoting gluconeogenesis and opposing the action of insulin.

Question 68

A patient on insulin therapy begins taking a sympathomimetic medication for nasal congestion. What effect might this new medication have on the patient’s insulin requirements?
A. Insulin requirements may decrease due to the enhanced hypoglycemic effect.
B. Insulin requirements may increase due to the hyperglycemic effects of sympathomimetics.
C. Insulin requirements will remain unchanged.
D. Sympathomimetics have no effect on blood glucose levels.

Answer 68

Correct Answer: B
Rationale: Sympathomimetics can raise blood glucose levels by stimulating the release of counterregulatory hormones, potentially increasing the need for insulin.

Question 69

The nurse is caring for a patient with diabetes who is prescribed both insulin and a beta blocker. The nurse knows that this combination can have which of the following effects?
A. Increased risk of hyperglycemia due to enhanced glycogenolysis.
B. Increased insulin sensitivity, leading to a need for lower insulin doses.
C. Decreased awareness of hypoglycemia symptoms, such as tachycardia and tremors.
D. Increased blood glucose control by preventing counterregulatory hormone effects.

Answer 69

Correct Answer: C
Rationale: Beta blockers can mask symptoms of hypoglycemia such as tachycardia and tremors, making it more challenging for the patient to recognize low blood sugar.

Question 70

Which of the following statements made by a patient taking insulin indicates a need for further education?
A. “I need to monitor my blood sugar closely when starting a new medication.”
B. “If I drink alcohol, I should eat food to prevent low blood sugar.”
C. “Taking glucocorticoids may cause my blood sugar to go lower.”
D. “Beta blockers can make it harder for me to notice if my blood sugar is low.”

Answer 70

Correct Answer: C
Rationale: Glucocorticoids are more likely to cause hyperglycemia, not hypoglycemia, by promoting gluconeogenesis and reducing insulin effectiveness.

Question 71

A nurse is educating a patient on insulin therapy about the effects of alcohol. Which statement by the patient indicates a correct understanding?
A. “Drinking alcohol will raise my blood sugar, so I should avoid it entirely.”
B. “Alcohol can lower my blood sugar, especially if I drink excessively without eating.”
C. “Alcohol has no effect on my blood sugar levels if I take insulin.”
D. “Drinking alcohol with insulin causes my body to produce more insulin naturally.”

Answer 71

Correct Answer: B
Rationale: Alcohol can cause hypoglycemia by inhibiting gluconeogenesis, especially when consumed excessively or on an empty stomach.

Question 72

A patient on insulin therapy is prescribed a sulfonylurea. What is the primary concern with this combination of medications?
A. Increased risk of insulin resistance.
B. Increased risk of hypoglycemia.
C. Decreased efficacy of insulin therapy.
D. Increased risk of hyperglycemia.

Answer 72

Correct Answer: B
Rationale: Sulfonylureas stimulate insulin secretion and can increase the risk of hypoglycemia when combined with insulin.

Question 73

A patient is starting a medication regimen that includes a beta blocker in addition to their insulin therapy. Which teaching point should the nurse prioritize?
A. “You may need to increase your insulin dose because beta blockers cause hyperglycemia.”
B. “Beta blockers will enhance the effects of insulin, so monitor for signs of low blood sugar.”
C. “Beta blockers may mask symptoms of low blood sugar, so monitor your glucose levels closely.”
D. “Beta blockers can interfere with your body’s insulin production, so take extra insulin if needed.”

Answer 73

Correct Answer: C
Rationale: Beta blockers can mask symptoms of hypoglycemia such as tachycardia and tremors, making it important for patients to monitor blood glucose levels closely.

Question 74

The nurse is caring for a patient receiving insulin therapy who is prescribed glucocorticoids for inflammation. Which action should the nurse anticipate?
A. Decreasing the patient’s insulin dose to prevent hypoglycemia.
B. Monitoring for signs of hypoglycemia due to enhanced insulin sensitivity.
C. Increasing the patient’s insulin dose to manage glucocorticoid-induced hyperglycemia.
D. Stopping insulin therapy while the patient is on glucocorticoids.

Answer 74

Correct Answer: C
Rationale: Glucocorticoids can increase blood glucose levels by stimulating gluconeogenesis and reducing insulin effectiveness, often requiring an adjustment to insulin dosing.

Question 75

Which of the following patients taking insulin therapy is at the highest risk for hypoglycemia?
A. A patient taking a glucocorticoid for asthma.
B. A patient consuming excessive alcohol on an empty stomach.
C. A patient taking a sympathomimetic for nasal congestion.
D. A patient who recently stopped taking a sulfonylurea.

Answer 75

Correct Answer: B
Rationale: Excessive alcohol consumption can inhibit gluconeogenesis and lead to hypoglycemia, especially if consumed without food.

Question 76

A patient with diabetes is prescribed both insulin and a sympathomimetic for asthma management. The nurse anticipates what effect on the patient’s blood glucose levels?
A. Sympathomimetics will increase blood glucose levels by counteracting insulin.
B. Sympathomimetics will decrease blood glucose levels by increasing insulin sensitivity.
C. Sympathomimetics will have no effect on blood glucose levels.
D. Sympathomimetics will enhance insulin secretion, leading to hypoglycemia.

Answer 76

Correct Answer: A
Rationale: Sympathomimetics can raise blood glucose levels by stimulating counterregulatory hormone release, which opposes the action of insulin.

Question 77

A nurse is caring for a patient with type 2 diabetes mellitus (T2DM) prescribed metformin. Which of the following statements by the patient indicates a need for further teaching?
A. “I need to inform my doctor if I develop symptoms like rapid breathing and muscle aches.”
B. “This medication lowers my blood sugar, so I need to monitor for signs of hypoglycemia.”
C. “If I’m scheduled for a procedure with iodine contrast, I should stop taking metformin beforehand.”
D. “I should let my provider know if I consume alcohol regularly.”

Answer 77

Correct Answer: B
Rationale: Metformin does not lower blood sugar directly and does not cause hypoglycemia. The patient needs further education about the mechanism of action of metformin.

Question 78

A nurse is reviewing a patient’s medical history before starting metformin. Which condition is a contraindication to this therapy?
A. Controlled hypertension
B. Renal impairment
C. Type 2 diabetes mellitus
D. Hyperlipidemia

Answer 78

Correct Answer: B
Rationale: Metformin is contraindicated in patients with renal impairment due to the risk of lactic acidosis, a rare but potentially fatal complication.

Question 79

A patient with polycystic ovary syndrome (PCOS) is prescribed metformin. What should the nurse include in the patient’s teaching?
A. “This medication directly lowers blood sugar levels and increases fertility.”
B. “You may experience nausea or diarrhea, which are common side effects.”
C. “Metformin will resolve PCOS symptoms within a week of starting treatment.”
D. “You should stop taking the medication if you experience GI symptoms.”

Answer 79

Correct Answer: B
Rationale: GI symptoms like nausea and diarrhea are common with metformin. Patients should be advised that these side effects may subside over time and do not warrant stopping the medication unless severe.

Question 80

The nurse is monitoring a patient on sulfonylureas for adverse effects. Which finding should prompt immediate intervention?
A. Patient reports a 3-pound weight loss over two weeks.
B. Blood glucose is 50 mg/dL, and the patient is drowsy.
C. Patient reports frequent urination and thirst.
D. The patient has an upper respiratory infection.

Answer 80

Correct Answer: B
Rationale: Sulfonylureas can cause hypoglycemia. A blood glucose level of 50 mg/dL, especially with symptoms of drowsiness, requires immediate intervention to prevent severe hypoglycemia.

Question 81

A nurse is providing patient education for a newly prescribed sodium-glucose co-transporter 2 (SGLT-2) inhibitor. Which statement should the nurse include?
A. “This medication may cause an increased risk of fungal infections.”
B. “Be sure to reduce your fluid intake to prevent side effects.”
C. “This medication works by stimulating your pancreas to release more insulin.”
D. “You will need to monitor for signs of liver toxicity with this drug.”

Answer 81

Correct Answer: A
Rationale: SGLT-2 inhibitors can increase the risk of fungal genitourinary infections, especially in females, due to the excretion of glucose in the urine.

Question 82

A nurse is teaching a patient taking gliptins (DPP-4 inhibitors) for type 2 diabetes mellitus. Which of the following statements by the patient indicates correct understanding?
A. “This medication prevents glucose from being absorbed in my intestine.”
B. “I need to stop this medication immediately if I develop severe abdominal pain.”
C. “I may experience low blood sugar while taking this medication alone.”
D. “This medication will stimulate my pancreas to release more insulin.”

Answer 82

Correct Answer: B
Rationale: Gliptins (DPP-4 inhibitors) can cause pancreatitis, which presents as severe abdominal pain. Patients should be advised to stop the medication and notify their healthcare provider immediately if this occurs.

Question 83

A patient taking metformin reports new-onset fatigue and numbness in their hands and feet. What should the nurse do next?
A. Check the patient’s hemoglobin A1C level.
B. Recommend the patient take a multivitamin with iron.
C. Assess the patient’s vitamin B12 levels.
D. Teach the patient to increase their folic acid intake.

Answer 83

Correct Answer: C
Rationale: Long-term use of metformin can decrease vitamin B12 absorption, leading to symptoms of deficiency such as fatigue and peripheral neuropathy.

Question 84

Which drug interaction should a nurse monitor for in a patient prescribed metformin and preparing for an imaging procedure with iodine contrast?
A. Increased risk of hypoglycemia
B. Acute renal failure
C. Increased blood glucose levels
D. Weight gain

Answer 84

Correct Answer: B
Rationale: Iodine contrast can increase the risk of renal failure, which may lead to the accumulation of metformin and a higher risk of lactic acidosis.

Question 85

A patient taking sulfonylureas asks why they need to avoid alcohol. What is the nurse’s best response?
A. “Alcohol can increase your blood sugar and make the medication less effective.”
B. “Alcohol increases your risk of severe hypoglycemia while on this medication.”
C. “Drinking alcohol will cancel out the effects of the sulfonylurea.”
D. “There are no risks associated with drinking alcohol and taking sulfonylureas.”

Answer 85

Correct Answer: B
Rationale: Alcohol increases the risk of hypoglycemia when combined with sulfonylureas due to its impact on liver glucose production.