Which insulin normally has a cloudy appearance in the vial?
Insulin isophane
✓
Insulin glargine
Insulin lispro
Insulin aspart
Correct Answer
Insulin isophane
Insulin isophane, also called NPH, is a suspension of insulin bound to a protein that slows absorption, so it looks cloudy and must be gently mixed before each dose. Insulin glargine is a clear long-acting solution. Insulin lispro is a clear rapid-acting solution. Insulin aspart is also a clear rapid-acting solution, and a clear insulin that turns cloudy should be discarded.
Category: Insulin Types
Question 2
How should the nurse resuspend a vial of NPH insulin before drawing up a dose?
Shake the vial hard until it foams
Roll the vial gently between the palms
✓
Warm the vial briefly in a microwave
Let the vial stand until it turns clear
Correct Answer
Roll the vial gently between the palms
Rolling the vial gently between the palms evenly disperses the suspended insulin without damaging it, so each dose carries the right amount. Shaking the vial hard creates bubbles that make the dose inaccurate. Warming the vial in a microwave can destroy the insulin protein. Letting it stand allows the particles to settle, so the dose drawn would be wrong.
Category: Injection Teaching
Question 3
A client with type 1 diabetes has the flu and is eating very little. The client asks whether to take insulin. What should the nurse teach?
Skip insulin until eating normally
Stop insulin and drink only water
Keep taking insulin as prescribed
✓
Take insulin only on days without fever
Correct Answer
Keep taking insulin as prescribed
Illness raises stress hormones that push blood glucose up, and a person with type 1 diabetes who stops insulin can develop ketoacidosis, so insulin is continued, glucose is checked more often, fluids are encouraged and the provider is called about dose changes. Skipping insulin until eating normally invites ketoacidosis. Stopping insulin and drinking only water removes the drug the body cannot make. Taking insulin only on days without fever leaves the client without insulin when needs are highest.
Category: Hypoglycemia and Sick Days
Question 4
A client taking insulin is shaky, sweaty and anxious, is fully alert, and has a low fingerstick glucose. What should the nurse give first?
Glucagon by injection
The scheduled insulin dose
A cheese and cracker snack
A glass of fruit juice
✓
Correct Answer
A glass of fruit juice
An alert client who can swallow is treated with a fast-acting carbohydrate such as fruit juice, glucose tablets or regular soda, and glucose is rechecked after a short wait. Glucagon by injection is reserved for a client who cannot safely swallow. The scheduled insulin dose would drive glucose even lower. A cheese and cracker snack contains fat and protein that slow absorption, so it is used after recovery rather than as the first treatment.
Category: Hypoglycemia and Sick Days
Question 5
After a family member gives glucagon to a person who is unconscious from low blood glucose, how should the person be positioned?
On the side
✓
Flat on the back
Sitting upright in a chair
Face down with legs raised
Correct Answer
On the side
Glucagon often causes nausea and vomiting as the person wakes, so turning the person onto the side protects the airway from aspiration. Lying flat on the back raises the risk of choking on vomit. Sitting upright in a chair is unsafe for someone who is unconscious. Lying face down with legs raised makes the airway hard to watch and protect.
Category: Glucagon
Question 6
Which form of glucagon can a family member give without using a needle?
Sublingual tablet
Nasal powder
✓
Rectal suppository
Transdermal patch
Correct Answer
Nasal powder
Glucagon is available as a nasal powder that is sprayed into one nostril and absorbed through the nasal lining, so it works even when the person is unconscious and cannot swallow. A sublingual tablet is not a glucagon form and would be unsafe in an unconscious person. A rectal suppository is not available for glucagon. A transdermal patch works far too slowly for an emergency and is not a glucagon form.
Category: Glucagon
Question 7
A client has taken metformin for many years and now has numbness in the feet and fatigue. Which deficiency should the nurse expect the provider to check?
Vitamin C
Vitamin K
Vitamin B12
✓
Vitamin A
Correct Answer
Vitamin B12
Long-term metformin use reduces absorption of vitamin B12, which can cause anemia and neuropathy that may be mistaken for diabetic nerve damage, so B12 levels are checked periodically. Vitamin C deficiency causes bleeding gums and poor wound healing and is not linked to metformin. Vitamin K deficiency causes bleeding. Vitamin A deficiency causes night blindness.
Category: Oral Antidiabetic Drugs
Question 8
A hospitalized client who takes glipizide has been made NPO for a procedure. What should the nurse do about the morning glipizide dose?
Give it with a sip of water as usual
Give it after the procedure with a snack
Give half of it and recheck glucose
Hold it and check with the provider
✓
Correct Answer
Hold it and check with the provider
Glipizide is a sulfonylurea that makes the pancreas release insulin whether or not the client eats, so giving it to a client who cannot eat risks hypoglycemia; the nurse holds the dose and clarifies with the provider. Giving it as usual ignores the missing meal. Giving it after the procedure with a snack changes the order without a prescription. Giving half of the dose is an unprescribed dose change.
Category: Oral Antidiabetic Drugs
Question 9
A client who takes acarbose with insulin becomes hypoglycemic. Which treatment raises blood glucose most reliably?
Glucose tablets
✓
Table sugar stirred into water
Hard candy
A slice of toast
Correct Answer
Glucose tablets
Acarbose blocks the intestinal enzymes that break down complex carbohydrates and table sugar, so hypoglycemia is treated with glucose itself, such as glucose tablets or gel, which needs no digestion. Table sugar stirred into water is sucrose, whose breakdown is slowed by the drug. Hard candy is mostly sucrose as well. A slice of toast is starch, which also needs the blocked enzymes.
Category: Oral Antidiabetic Drugs
Question 10
A client who takes repaglinide before meals plans to skip lunch. What should the nurse teach?
Take the dose with water anyway
Skip that dose as well
✓
Double the dose before dinner
Take that dose at bedtime
Correct Answer
Skip that dose as well
Repaglinide causes a brief burst of insulin release timed to a meal, so if a meal is skipped its dose is skipped too to avoid hypoglycemia. Taking the dose anyway without food invites low glucose. Doubling the dose before dinner raises the risk of a severe low. Taking the dose at bedtime would release insulin overnight with no food to match it.
Category: Oral Antidiabetic Drugs
Question 11
Before a client starts semaglutide, the nurse asks about a personal or family history of which condition?
Hashimoto thyroiditis
Type 1 diabetes in a parent
Medullary thyroid carcinoma
✓
Iron deficiency anemia
Correct Answer
Medullary thyroid carcinoma
GLP-1 receptor agonists carry a boxed warning about thyroid C-cell tumors seen in rodents and are contraindicated with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2; clients report a neck lump, hoarseness or trouble swallowing. Hashimoto thyroiditis is not a contraindication. Type 1 diabetes in a parent does not affect the use of the drug. Iron deficiency anemia is unrelated to this warning.
Category: Non-Insulin Injectables
Question 12
A client taking liraglutide reports severe, constant abdominal pain that spreads to the back, with vomiting. What should the nurse tell the client?
Take the next dose with a larger meal
Take an antacid and continue the drug
Switch the injection to the thigh
Stop the drug and seek care right away
✓
Correct Answer
Stop the drug and seek care right away
Severe persistent abdominal pain radiating to the back, with or without vomiting, may signal pancreatitis, a warning for GLP-1 receptor agonists, so the drug is stopped and the client is evaluated promptly. Taking the next dose with a larger meal would delay care for a dangerous problem. Taking an antacid and continuing the drug masks the warning sign. Switching the injection site does not change the drug's effect on the pancreas.
Category: Non-Insulin Injectables
Question 13
When pramlintide is added to a client's mealtime insulin, which change does the nurse expect?
A lower mealtime insulin dose
✓
A higher mealtime insulin dose
Stopping the basal insulin
Mixing both drugs in one syringe
Correct Answer
A lower mealtime insulin dose
Pramlintide slows gastric emptying and lowers glucagon after meals, and with insulin it can cause severe hypoglycemia, especially in type 1 diabetes, so the mealtime insulin dose is reduced when it is started and glucose is checked often. A higher mealtime insulin dose would increase that risk. Stopping the basal insulin is not part of starting pramlintide. Mixing both drugs in one syringe is not allowed; they are given as separate injections.
Category: Non-Insulin Injectables
Question 14
Before pioglitazone is started, which laboratory test does the nurse expect to be obtained?
Serum amylase
Liver enzymes
✓
Thyroid hormone levels
Vitamin B12 level
Correct Answer
Liver enzymes
Thiazolidinediones have been linked to liver injury, so liver enzymes are checked before pioglitazone is started and when symptoms such as jaundice, dark urine or right upper abdominal pain appear. Serum amylase is used to assess the pancreas. Thyroid hormone levels are not required before this drug. A vitamin B12 level is followed with long-term metformin.
Category: Oral Antidiabetic Drugs
Question 15
Why does sitagliptin used alone seldom drive blood glucose too low?
It is taken only when blood glucose is high
It raises glucagon release between meals
Its boost to insulin release depends on glucose levels
✓
It is removed from the body within minutes
Correct Answer
Its boost to insulin release depends on glucose levels
Sitagliptin blocks the enzyme that breaks down incretin hormones, and incretins increase insulin release mainly when glucose is elevated, so the effect fades as glucose normalizes. It is not taken only when blood glucose is high; it is a scheduled drug. It lowers, rather than raises, glucagon release. It is not removed within minutes; its effect lasts through the day.
Category: Oral Antidiabetic Drugs
Question 16
Which vial of insulin should the nurse discard?
An unopened vial kept in the refrigerator
A recently opened vial kept at room temperature
A cloudy vial of NPH insulin
A vial that was accidentally frozen
✓
Correct Answer
A vial that was accidentally frozen
Freezing damages the insulin protein, so any insulin that has been frozen is discarded even if it looks normal after thawing. An unopened vial kept in the refrigerator is stored correctly. A recently opened vial kept at room temperature is acceptable until its in-use expiration. A cloudy vial of NPH insulin is normal, because NPH is a suspension.
Category: Injection Teaching
Question 17
Which finding suggests high rather than low blood glucose in a client with diabetes?
Excessive thirst and frequent urination
✓
Shakiness and sweating
Pounding heartbeat and anxiety
Cool, clammy skin
Correct Answer
Excessive thirst and frequent urination
High glucose spills into the urine and pulls water with it, causing frequent urination and thirst, along with warm dry skin and fatigue. Shakiness and sweating are typical of hypoglycemia. A pounding heartbeat and anxiety are adrenergic signs of hypoglycemia. Cool, clammy skin also points to low glucose.
Category: Hypoglycemia and Sick Days
Question 18
Insulin is usually absorbed fastest from which injection site?
Thigh
Abdomen
✓
Buttock
Upper arm
Correct Answer
Abdomen
Insulin is generally absorbed most quickly from the abdomen, so many clients use it for mealtime doses and rotate within the area. The thigh absorbs insulin more slowly, unless the leg is exercised soon after the injection. The buttock is usually the slowest site. The upper arm absorbs at an intermediate rate.
Category: Injection Teaching
Question 19
A client takes a GLP-1 receptor agonist with a sulfonylurea. Which adverse effect becomes more likely with this combination?
Lactic acidosis
Hyperkalemia
Hypoglycemia
✓
Hypertension
Correct Answer
Hypoglycemia
A GLP-1 receptor agonist alone seldom causes low glucose, but combined with a sulfonylurea or insulin the risk of hypoglycemia rises, so the dose of the sulfonylurea or insulin may be lowered. Lactic acidosis is the rare serious risk tied to metformin. Hyperkalemia is not an expected effect of this combination. Hypertension is not caused by these drugs; GLP-1 agonists may even lower blood pressure slightly.
Category: Non-Insulin Injectables
Question 20
What should the nurse teach a client who uses an insulin pen?
Shake the pen hard before each injection
Leave the needle attached between doses
Reuse the needle until it feels dull
Prime the pen before each injection
✓
Correct Answer
Prime the pen before each injection
Priming a small amount of insulin before each injection removes air and confirms that insulin flows through the needle, so the full dose is delivered. Shaking the pen hard creates bubbles. Leaving the needle attached between doses lets air in and insulin leak out. Reusing a needle dulls and bends the tip, increases pain and tissue damage, and raises infection risk.
Category: Injection Teaching