🩸 Introduction
Managing diabetes is one of the most critical responsibilities in nursing care. The NCLEX exam frequently includes questions about insulin administration, patient teaching, hypoglycemia management, and long-term complications of diabetes. Understanding these topics not only helps you pass the exam but also prepares you for real-world nursing challenges.
This comprehensive practice set of 100 NCLEX Diabetes Management Questions is designed to strengthen your understanding of glucose control, insulin therapy, diabetic ketoacidosis (DKA), and lifestyle management. Each question is followed by a clear rationale, ensuring deep learning and exam readiness.
🩸 Part 1: NCLEX Diabetes Management Practice Questions (1–25)
1. A nurse is teaching a newly diagnosed diabetic patient about insulin injection sites. Which area provides the most consistent absorption?
A. Buttocks
B. Abdomen
C. Upper arm
D. Thigh
✅ Correct Answer: B. Abdomen
Rationale: The abdomen provides the most consistent absorption of insulin due to better blood flow and thinner subcutaneous tissue. Rotating within the same area prevents lipodystrophy.
2. A patient with Type 1 diabetes reports shakiness and sweating. The nurse should first:
A. Administer long-acting insulin
B. Give 15g of simple carbohydrates
C. Check urine ketones
D. Start an IV line
✅ Correct Answer: B. Give 15g of simple carbohydrates
Rationale: These are signs of hypoglycemia. The “15-15 rule” (15g carbohydrates, recheck glucose in 15 minutes) is the first action.
3. Which of the following insulins has the fastest onset of action?
A. NPH
B. Regular insulin
C. Lispro
D. Glargine
✅ Correct Answer: C. Lispro
Rationale: Lispro (Humalog) is a rapid-acting insulin with onset in 10–15 minutes, ideal for mealtime use.
4. The nurse should instruct a diabetic patient to administer insulin glargine (Lantus):
A. Before each meal
B. Only at bedtime
C. Once daily, same time each day
D. Whenever glucose rises
✅ Correct Answer: C. Once daily, same time each day
Rationale: Glargine is a long-acting insulin providing basal coverage for 24 hours. Timing consistency maintains stable glucose levels.
5. A diabetic patient presents with fruity breath, deep respirations, and abdominal pain. Which condition should the nurse suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic syndrome
D. Lactic acidosis
✅ Correct Answer: B. Diabetic ketoacidosis
Rationale: Fruity breath and Kussmaul respirations are hallmark signs of DKA due to fat breakdown and ketone accumulation.
6. Which of the following lab values requires immediate intervention?
A. Fasting glucose of 115 mg/dL
B. HbA1c of 6.2%
C. Random glucose of 320 mg/dL
D. Postprandial glucose of 145 mg/dL
✅ Correct Answer: C. Random glucose of 320 mg/dL
Rationale: A glucose >300 mg/dL indicates uncontrolled diabetes and possible DKA or HHS.
7. What is the best indicator of long-term glucose control?
A. Daily fasting glucose
B. Urine glucose test
C. HbA1c
D. Glucose tolerance test
✅ Correct Answer: C. HbA1c
Rationale: HbA1c reflects average blood glucose levels over 2–3 months and is used to assess treatment effectiveness.
8. A nurse monitors a diabetic patient receiving IV insulin. Which electrolyte must be closely monitored?
A. Calcium
B. Sodium
C. Potassium
D. Magnesium
✅ Correct Answer: C. Potassium
Rationale: Insulin drives potassium into cells, potentially causing hypokalemia. Continuous cardiac monitoring is essential.
9. A patient with Type 2 diabetes is prescribed metformin. The nurse should instruct the patient to avoid:
A. High-protein diet
B. Taking it with food
C. Alcohol
D. Daily exercise
✅ Correct Answer: C. Alcohol
Rationale: Alcohol with metformin increases the risk of lactic acidosis — a rare but serious complication.
10. When should a diabetic patient check for ketones in urine?
A. After exercise
B. When glucose >240 mg/dL
C. Every morning
D. After meals
✅ Correct Answer: B. When glucose >240 mg/dL
Rationale: Ketone testing is indicated during hyperglycemia or illness to detect early DKA.
11. A patient taking NPH insulin should be taught that the peak effect occurs in:
A. 1 hour
B. 2–4 hours
C. 6–8 hours
D. 10–12 hours
✅ Correct Answer: C. 6–8 hours
Rationale: NPH is an intermediate-acting insulin; its peak is the time of greatest hypoglycemia risk.
12. The nurse recognizes that which finding indicates hypoglycemia?
A. Flushed skin and thirst
B. Confusion and diaphoresis
C. Polyuria and weight loss
D. Kussmaul respirations
✅ Correct Answer: B. Confusion and diaphoresis
Rationale: Early hypoglycemia manifests as confusion, sweating, and tremors due to low brain glucose.
13. Which dietary instruction is most appropriate for a diabetic patient?
A. Avoid all carbohydrates
B. Eat a consistent carbohydrate diet
C. Limit protein intake
D. Skip meals if not hungry
✅ Correct Answer: B. Eat a consistent carbohydrate diet
Rationale: Consistency in carbohydrate intake helps maintain stable glucose levels and aligns with insulin schedules.
14. The nurse is educating a patient about foot care. Which statement indicates understanding?
A. “I’ll walk barefoot to improve circulation.”
B. “I’ll use hot water for foot baths.”
C. “I’ll check my feet daily for sores.”
D. “I’ll trim my toenails close to the skin.”
✅ Correct Answer: C. “I’ll check my feet daily for sores.”
Rationale: Daily inspection prevents infection and ulceration — critical for diabetic neuropathy management.
15. Which insulin should never be mixed with other insulins?
A. Regular insulin
B. NPH
C. Glargine
D. Lispro
✅ Correct Answer: C. Glargine
Rationale: Insulin glargine has a low pH and should not be mixed as it alters its long-acting properties.
16. A patient experiences hypoglycemia while unconscious. The nurse should administer:
A. 15g of oral glucose
B. Glucagon IM
C. Regular insulin
D. Metformin PO
✅ Correct Answer: B. Glucagon IM
Rationale: For unconscious patients, glucagon or IV dextrose is the emergency treatment.
17. A diabetic patient is scheduled for surgery. The nurse anticipates holding:
A. NPH insulin
B. Sliding-scale insulin
C. Metformin
D. Short-acting insulin
✅ Correct Answer: C. Metformin
Rationale: Metformin is withheld before surgery due to risk of lactic acidosis when contrast or anesthesia is used.
18. Which sign indicates diabetic neuropathy?
A. Blurred vision
B. Tingling in feet
C. Increased urination
D. Weight gain
✅ Correct Answer: B. Tingling in feet
Rationale: Peripheral nerve damage causes numbness, tingling, or burning sensations in extremities.
19. The nurse teaches a diabetic patient about the “Rule of 15.” What does it mean?
A. Take insulin 15 minutes before meals
B. Eat 15 grams of carbs, recheck sugar in 15 minutes
C. Drink 15 oz of juice for hypoglycemia
D. Exercise for 15 minutes daily
✅ Correct Answer: B. Eat 15 grams of carbs, recheck sugar in 15 minutes
Rationale: Standard emergency management for mild hypoglycemia.
20. Which of the following is an example of rapid-acting insulin?
A. Lispro
B. NPH
C. Detemir
D. Glargine
✅ Correct Answer: A. Lispro
Rationale: Rapid-acting insulins like Lispro or Aspart start working within 15 minutes and last 3–4 hours.
21. The nurse teaches the patient that exercise may:
A. Increase blood glucose
B. Decrease insulin sensitivity
C. Lower blood glucose
D. Increase ketone production
✅ Correct Answer: C. Lower blood glucose
Rationale: Exercise enhances insulin sensitivity and glucose uptake by muscles.
22. Which condition is an emergency in diabetic patients?
A. Hypoglycemia
B. Hyperglycemia
C. Mild nausea
D. Polyphagia
✅ Correct Answer: A. Hypoglycemia
Rationale: Hypoglycemia develops rapidly and can cause seizures or death if untreated.
23. What should a nurse include in teaching about insulin storage?
A. Store in freezer
B. Keep unopened vials in refrigerator
C. Keep all insulin at room temperature
D. Shake before use
✅ Correct Answer: B. Keep unopened vials in refrigerator
Rationale: Insulin remains stable when refrigerated; opened vials can be kept at room temperature for 28 days.
24. A patient asks about using insulin pens. The nurse should respond:
A. “They provide inaccurate doses.”
B. “They are convenient and increase accuracy.”
C. “They are not recommended for long-term use.”
D. “They require refrigeration after each use.”
✅ Correct Answer: B. “They are convenient and increase accuracy.”
Rationale: Insulin pens are user-friendly and reduce dosing errors, ideal for patients with visual or dexterity issues.
25. Which lifestyle modification is most effective in Type 2 diabetes?
A. Increasing protein
B. Weight reduction and regular exercise
C. Avoiding carbohydrates completely
D. High-fat diet
✅ Correct Answer: B. Weight reduction and regular exercise
Rationale: Weight loss and consistent physical activity improve insulin sensitivity and glycemic control.
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🩸 Part 2: NCLEX Diabetes Management Practice Questions (26–50)
26. Which action by a diabetic patient indicates understanding of sick day management?
A. Stop taking insulin until eating normally
B. Increase fluid intake and monitor glucose frequently
C. Skip glucose checks
D. Double insulin doses
✅ Correct Answer: B. Increase fluid intake and monitor glucose frequently
Rationale: During illness, glucose can rise even without eating; fluids and frequent checks prevent dehydration and DKA.
27. A patient taking insulin develops lipohypertrophy. The nurse should advise the patient to:
A. Use the same site for injections
B. Massage the injection site
C. Rotate injection sites
D. Use larger needles
✅ Correct Answer: C. Rotate injection sites
Rationale: Lipohypertrophy occurs from repeated injections at the same site, impairing absorption; site rotation prevents it.
28. The nurse suspects hypoglycemia in a conscious patient. What is the nurse’s priority action?
A. Give orange juice
B. Call the physician
C. Administer insulin
D. Check blood pressure
✅ Correct Answer: A. Give orange juice
Rationale: A fast-acting carbohydrate source is the priority intervention for conscious hypoglycemic patients.
29. A diabetic patient taking prednisone develops increased glucose levels. The nurse understands:
A. Prednisone increases insulin sensitivity
B. Corticosteroids elevate blood glucose
C. Glucose monitoring can be stopped
D. Prednisone lowers glucose absorption
✅ Correct Answer: B. Corticosteroids elevate blood glucose
Rationale: Corticosteroids increase hepatic glucose production and insulin resistance; glucose monitoring should be increased.
30. Which finding indicates effective diabetic management?
A. Fasting glucose of 150 mg/dL
B. HbA1c of 6.5%
C. Random glucose of 210 mg/dL
D. Polyuria and fatigue
✅ Correct Answer: B. HbA1c of 6.5%
Rationale: HbA1c below 7% is considered good control for most adults with diabetes.
31. The nurse should instruct a diabetic patient to carry which item during travel?
A. Extra insulin in checked luggage
B. Glucose tablets or candy
C. High-fat snacks
D. No special items needed
✅ Correct Answer: B. Glucose tablets or candy
Rationale: Always carry quick-acting carbohydrate sources to manage unexpected hypoglycemia during travel.
32. What is the goal of diabetic meal planning?
A. Complete avoidance of sugar
B. Maintaining stable glucose and healthy weight
C. Maximizing carbohydrate intake
D. Skipping meals when glucose is normal
✅ Correct Answer: B. Maintaining stable glucose and healthy weight
Rationale: Balanced nutrition with regular meals prevents glucose spikes and maintains overall metabolic stability.
33. The nurse should monitor for which complication of poorly controlled diabetes?
A. Pancreatitis
B. Neuropathy and nephropathy
C. Liver cirrhosis
D. Appendicitis
✅ Correct Answer: B. Neuropathy and nephropathy
Rationale: Long-term hyperglycemia damages small blood vessels, leading to kidney and nerve damage.
34. The nurse explains that exercise should be avoided if:
A. Glucose is 140 mg/dL
B. Ketones are present in urine
C. The patient just ate
D. The weather is warm
✅ Correct Answer: B. Ketones are present in urine
Rationale: Exercise with ketonuria worsens hyperglycemia and DKA risk; defer exercise until glucose stabilizes.
35. The nurse teaches that insulin absorption is increased by:
A. Cold compress on the site
B. Massaging and exercising the injected area
C. Injecting in scar tissue
D. Skipping doses
✅ Correct Answer: B. Massaging and exercising the injected area
Rationale: Heat, massage, or activity near the site increases insulin absorption — caution for hypoglycemia.
36. The nurse observes a patient taking insulin using alcohol wipes, letting the site dry, and rotating locations. What does this indicate?
A. Incorrect technique
B. Risk for infection
C. Proper insulin administration
D. Ineffective glucose control
✅ Correct Answer: C. Proper insulin administration
Rationale: Cleaning, drying, and rotating are all correct steps that ensure safety and absorption efficiency.
37. The nurse expects which order for a patient with DKA?
A. Administer oral glucose
B. Give IV regular insulin and fluids
C. Hold insulin until glucose normalizes
D. Restrict fluids
✅ Correct Answer: B. Give IV regular insulin and fluids
Rationale: IV regular insulin lowers glucose and ketones, while IV fluids correct dehydration and electrolyte imbalance.
38. Which statement by a patient with Type 2 diabetes indicates correct understanding?
A. “I only need insulin when I feel weak.”
B. “Diet and exercise can help control my blood sugar.”
C. “Once I start insulin, I can eat freely.”
D. “My diabetes will go away if I lose weight.”
✅ Correct Answer: B. “Diet and exercise can help control my blood sugar.”
Rationale: Lifestyle changes are foundational for managing Type 2 diabetes effectively.
39. The nurse should question which order for a diabetic patient undergoing CT scan with contrast?
A. Hold metformin
B. Administer IV fluids
C. Continue insulin
D. Continue metformin as usual
✅ Correct Answer: D. Continue metformin as usual
Rationale: Metformin is held before and after contrast use due to lactic acidosis risk.
40. A nurse identifies which symptom as classic for hyperglycemia?
A. Diaphoresis
B. Polyuria
C. Tremors
D. Confusion
✅ Correct Answer: B. Polyuria
Rationale: Excess glucose in blood leads to osmotic diuresis, causing frequent urination.
41. The nurse prepares to administer 70/30 insulin. What does this combination include?
A. 70% regular, 30% NPH
B. 70% NPH, 30% regular
C. 70% glargine, 30% lispro
D. 70% rapid, 30% long
✅ Correct Answer: B. 70% NPH, 30% regular
Rationale: 70/30 is a premixed insulin providing both basal (NPH) and mealtime (regular) coverage.
42. When teaching self-monitoring of blood glucose, the nurse should emphasize:
A. Using any lancet depth
B. Testing at consistent times daily
C. Reusing test strips
D. Avoiding glucose checks at bedtime
✅ Correct Answer: B. Testing at consistent times daily
Rationale: Consistent testing helps identify patterns and guides insulin and diet adjustments.
43. The nurse identifies which food as a source of simple carbohydrates?
A. Brown rice
B. Whole wheat bread
C. Apple juice
D. Lentils
✅ Correct Answer: C. Apple juice
Rationale: Simple carbs like juice or candy provide rapid glucose for hypoglycemia correction.
44. A diabetic patient with blurred vision and poor wound healing likely has:
A. Hypoglycemia
B. Hyperglycemia
C. Hypocalcemia
D. Hyperkalemia
✅ Correct Answer: B. Hyperglycemia
Rationale: High glucose impairs immune and vascular function, delaying wound healing and affecting vision.
45. A patient reports numbness in fingers and toes. The nurse recognizes this as:
A. Autonomic neuropathy
B. Peripheral neuropathy
C. Retinopathy
D. Nephropathy
✅ Correct Answer: B. Peripheral neuropathy
Rationale: Nerve damage from long-term hyperglycemia commonly affects extremities first.
46. For an unconscious diabetic patient in ER, the first nursing action is:
A. Give insulin
B. Check blood sugar
C. Administer glucagon
D. Notify physician
✅ Correct Answer: B. Check blood sugar
Rationale: Always assess blood glucose before intervention to differentiate hypo- vs. hyperglycemia.
47. The nurse advises a diabetic patient to schedule eye exams:
A. Every 2 years
B. Every 6 months
C. Annually
D. Only if vision changes
✅ Correct Answer: C. Annually
Rationale: Early detection of diabetic retinopathy prevents vision loss.
48. The nurse should teach a patient on metformin to report:
A. Mild diarrhea
B. Muscle cramps
C. Unexplained fatigue or rapid breathing
D. Increased appetite
✅ Correct Answer: C. Unexplained fatigue or rapid breathing
Rationale: These may indicate lactic acidosis, a rare but serious metformin side effect.
49. A diabetic patient is taught to carry an identification card because:
A. It is required by law
B. It helps in emergencies if patient becomes unconscious
C. It lowers insurance cost
D. It replaces glucose monitoring
✅ Correct Answer: B. It helps in emergencies if patient becomes unconscious
Rationale: Medical ID alerts healthcare providers to diabetes status during emergencies.
50. The nurse recognizes that an HbA1c value of 9% means:
A. Good control
B. Poor control of glucose
C. Hypoglycemia
D. Normal value
✅ Correct Answer: B. Poor control of glucose
Rationale: An HbA1c above 8% indicates uncontrolled diabetes, requiring treatment adjustment.
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🩺 Part 3: NCLEX Diabetes Management Questions (51 – 75)
51. A patient is prescribed insulin glargine at bedtime. What key teaching should the nurse provide?
A. Mix glargine with short-acting insulin.
B. Administer in the morning.
C. Do not mix with other insulins.
D. Take with meals.
✅ Answer: C. Do not mix with other insulins.
Rationale: Insulin glargine is a long-acting insulin and must never be mixed because it alters stability and absorption.
52. A patient with Type 1 diabetes reports nausea and vomiting. What is the nurse’s first action?
A. Stop insulin.
B. Check blood glucose and urine ketones.
C. Encourage rest only.
D. Offer soda.
✅ Answer: B. Check blood glucose and urine ketones.
Rationale: Nausea and vomiting may signal DKA; immediate assessment of glucose and ketones is essential.
53. The nurse recognizes which symptom as typical of diabetic ketoacidosis (DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Shallow breathing
D. Cold, clammy skin
✅ Answer: B. Kussmaul respirations
Rationale: Deep, rapid breathing helps eliminate CO₂ and compensates for metabolic acidosis in DKA.
54. The nurse expects which IV fluid for initial management of DKA?
A. D5W
B. 0.9% normal saline
C. 3% hypertonic saline
D. 0.45% saline with dextrose
✅ Answer: B. 0.9% normal saline
Rationale: Isotonic fluids restore circulatory volume and correct dehydration before insulin is started.
55. What laboratory result is consistent with DKA?
A. pH 7.45, HCO₃ 26 mEq/L
B. pH 7.20, HCO₃ 14 mEq/L
C. pH 7.38, HCO₃ 22 mEq/L
D. pH 7.48, HCO₃ 30 mEq/L
✅ Answer: B. pH 7.20, HCO₃ 14 mEq/L
Rationale: Metabolic acidosis in DKA lowers pH and bicarbonate levels.
56. A nurse reviewing a Type 2 diabetic patient’s labs notes an HbA1c of 8.8%. The best nursing interpretation is:
A. Excellent control
B. Acceptable control
C. Poor control needing adjustment
D. Lab error
✅ Answer: C. Poor control needing adjustment
Rationale: HbA1c > 8% shows poor long-term glucose control and risk for complications.
57. Which insulin has the fastest onset of action?
A. Regular (Humulin R)
B. NPH
C. Lispro (Humalog)
D. Glargine (Lantus)
✅ Answer: C. Lispro (Humalog)
Rationale: Lispro is rapid-acting and starts working within 15 minutes — ideal for mealtime coverage.
58. The nurse teaches a newly diagnosed diabetic to recognize hypoglycemia as:
A. Flushed skin, dry mouth, polyuria
B. Tremors, sweating, irritability
C. Slow pulse, confusion, warmth
D. Excessive thirst only
✅ Answer: B. Tremors, sweating, irritability
Rationale: Adrenergic stimulation from low glucose causes shakiness, diaphoresis, and mood changes.
59. A nurse administers rapid-acting insulin at 8 AM. When should the patient eat?
A. Immediately
B. After 30 minutes
C. After 1 hour
D. Two hours later
✅ Answer: A. Immediately
Rationale: Rapid-acting insulin peaks quickly; delaying meals causes hypoglycemia.
60. The nurse identifies which factor can falsely elevate glucose readings?
A. Cold fingers
B. Warm environment
C. Old test strips
D. Early-morning testing
✅ Answer: C. Old test strips
Rationale: Expired or improperly stored strips give inaccurate results; use fresh strips only.
61. For a patient with diabetic foot ulcer, the priority nursing action is:
A. Apply tight bandage
B. Keep the area dry and inspect daily
C. Apply powder to foot
D. Soak foot in hot water
✅ Answer: B. Keep the area dry and inspect daily
Rationale: Daily inspection and dry hygiene prevent infection and promote healing.
62. The nurse should question which breakfast order for a diabetic patient?
A. Scrambled eggs and toast
B. Pancakes with syrup
C. Oatmeal with fruit
D. Yogurt and berries
✅ Answer: B. Pancakes with syrup
Rationale: Refined carbohydrates cause rapid glucose spikes and should be limited.
63. Which medication may cause hypoglycemia when combined with insulin?
A. Corticosteroids
B. Beta-blockers
C. Oral contraceptives
D. Calcium channel blockers
✅ Answer: B. Beta-blockers
Rationale: Beta-blockers mask hypoglycemia symptoms and potentiate insulin effects.
64. A diabetic patient scheduled for surgery should be instructed to:
A. Skip morning insulin and monitor glucose
B. Take full insulin dose
C. Eat a large breakfast
D. Stop all medications
✅ Answer: A. Skip morning insulin and monitor glucose
Rationale: Patients are usually NPO before surgery; glucose should be monitored closely.
65. What is the main goal of insulin therapy in Type 1 diabetes?
A. Cure the disease
B. Mimic physiologic insulin secretion
C. Eliminate diet restrictions
D. Prevent exercise
✅ Answer: B. Mimic physiologic insulin secretion
Rationale: Basal-bolus therapy imitates normal insulin release for better control.
66. A nurse suspects Somogyi effect when:
A. Morning glucose is high after nighttime hypoglycemia
B. Glucose is low after meals
C. Glucose drops mid-morning
D. HbA1c is below 6%
✅ Answer: A. Morning glucose is high after nighttime hypoglycemia
Rationale: Rebound hyperglycemia occurs as a response to nocturnal lows.
67. The nurse should teach that Lantus insulin is given:
A. Once daily at the same time
B. Twice daily with meals
C. Only when glucose is high
D. Before each snack
✅ Answer: A. Once daily at the same time
Rationale: Glargine provides 24-hour basal control and is given consistently each day.
68. A diabetic patient receiving IV insulin should have which electrolyte monitored closely?
A. Sodium
B. Potassium
C. Calcium
D. Chloride
✅ Answer: B. Potassium
Rationale: Insulin drives potassium into cells, causing hypokalemia if unmonitored.
69. Which complication is a late sign of uncontrolled diabetes?
A. Retinopathy
B. Polyuria
C. Weight loss
D. Thirst
✅ Answer: A. Retinopathy
Rationale: Chronic microvascular damage affects the retina over years of poor control.
70. A patient with diabetes becomes sweaty, pale, and confused while walking. The nurse should first:
A. Offer half a cup of juice
B. Call the doctor
C. Give insulin
D. Have the patient sit down and rest
✅ Answer: A. Offer half a cup of juice
Rationale: Immediate carbohydrate correction treats hypoglycemia and restores glucose levels.
71. The nurse knows that macrovascular complications of diabetes include:
A. Retinopathy and neuropathy
B. Atherosclerosis and stroke
C. Nephropathy and renal failure
D. Cataracts
✅ Answer: B. Atherosclerosis and stroke
Rationale: Large vessel damage from hyperglycemia leads to cardiovascular disease.
72. Which finding suggests hypoglycemia unawareness?
A. Patient recognizes early signs
B. No warning symptoms before severe low glucose
C. Frequent hunger attacks
D. Excessive sweating
✅ Answer: B. No warning symptoms before severe low glucose
Rationale: Repeated lows blunt adrenergic response, masking early signs.
73. For home glucose monitoring, the nurse instructs:
A. Use alcohol swabs and let dry before lancing
B. Squeeze the finger hard for blood
C. Store strips in humidity
D. Test on unclean skin
✅ Answer: A. Use alcohol swabs and let dry before lancing
Rationale: Proper cleaning reduces infection risk and ensures accurate results.
74. Which dietary recommendation best supports diabetic control?
A. Eat three large meals per day
B. Consume consistent carbohydrate meals daily
C. Avoid all fruits
D. Skip breakfast if glucose is normal
✅ Answer: B. Consume consistent carbohydrate meals daily
Rationale: Stable carbohydrate intake maintains predictable glucose patterns.
75. Which instruction is most appropriate for diabetic foot care?
A. Walk barefoot at home
B. Use hot pads to warm feet
C. Check feet daily for cuts or blisters
D. Trim toenails close to skin
✅ Answer: C. Check feet daily for cuts or blisters
Rationale: Daily inspection prevents infection and detects injuries early in neuropathy patients.
🩺 Part 4: NCLEX Diabetes Management Questions (76–100)
76. A diabetic patient presents with confusion, diaphoresis, and tremors. What is the nurse’s first action?
A. Administer 1 mg glucagon IM
B. Recheck blood glucose in 30 minutes
C. Give 15 g of fast-acting carbohydrates
D. Notify the physician immediately
✅ Correct Answer: C. Give 15 g of fast-acting carbohydrates
Rationale: These symptoms suggest hypoglycemia. The immediate intervention is to provide a quick source of glucose, such as juice or glucose tablets.
77. Which insulin has the fastest onset of action?
A. Regular insulin
B. NPH insulin
C. Lispro (Humalog)
D. Glargine (Lantus)
✅ Correct Answer: C. Lispro (Humalog)
Rationale: Lispro is a rapid-acting insulin with an onset of 10–15 minutes, making it ideal to give just before meals.
78. A patient taking metformin is scheduled for a CT scan with contrast. What is the nurse’s priority action?
A. Continue metformin as prescribed
B. Hold metformin for 48 hours after the scan
C. Increase fluid intake
D. Administer insulin instead
✅ Correct Answer: B. Hold metformin for 48 hours after the scan
Rationale: Metformin should be held before and after contrast studies to prevent lactic acidosis due to renal impairment risk.
79. Which sign is most associated with diabetic ketoacidosis (DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Peripheral edema
D. Hypothermia
✅ Correct Answer: B. Kussmaul respirations
Rationale: DKA causes metabolic acidosis, leading to deep, rapid breathing known as Kussmaul respirations.
80. A nurse is educating a patient with diabetes about foot care. Which statement indicates a need for further teaching?
A. “I will wear cotton socks.”
B. “I will walk barefoot indoors.”
C. “I will check my feet daily.”
D. “I will trim my toenails straight across.”
✅ Correct Answer: B. I will walk barefoot indoors
Rationale: Walking barefoot increases the risk of foot injury and infection due to neuropathy.
81. A diabetic patient on insulin reports nausea and vomiting. What is the best advice?
A. Skip the insulin dose
B. Take half the usual dose
C. Take insulin and try to eat simple carbohydrates
D. Double the insulin dose
✅ Correct Answer: C. Take insulin and try to eat simple carbohydrates
Rationale: Insulin should not be skipped; the patient should attempt small amounts of carbohydrates to prevent DKA.
82. What is the target HbA1c level for most diabetic adults?
A. Less than 7%
B. Less than 8%
C. Less than 6%
D. Less than 10%
✅ Correct Answer: A. Less than 7%
Rationale: Maintaining HbA1c below 7% indicates good long-term glycemic control.
83. Which insulin cannot be mixed with other insulins?
A. Regular
B. NPH
C. Glargine (Lantus)
D. Lispro (Humalog)
✅ Correct Answer: C. Glargine (Lantus)
Rationale: Glargine is a long-acting insulin that should never be mixed with other insulins in the same syringe.
84. Which of the following is a long-term complication of poorly controlled diabetes?
A. Retinopathy
B. Acute pancreatitis
C. Hypotension
D. Increased bone density
✅ Correct Answer: A. Retinopathy
Rationale: Chronic hyperglycemia damages small blood vessels, leading to diabetic retinopathy.
85. When teaching a patient about insulin storage, the nurse should instruct to:
A. Store in the freezer
B. Keep open vials at room temperature
C. Store all insulin in direct sunlight
D. Discard after 3 months of use
✅ Correct Answer: B. Keep open vials at room temperature
Rationale: Open insulin vials can be kept at room temperature for up to 28 days.
86. A patient with type 2 diabetes reports frequent nighttime hypoglycemia. What adjustment may be necessary?
A. Increase morning insulin
B. Reduce evening insulin dose
C. Eliminate bedtime snack
D. Skip breakfast insulin
✅ Correct Answer: B. Reduce evening insulin dose
Rationale: Reducing nighttime insulin or adding a bedtime snack can prevent nocturnal hypoglycemia.
87. What is the main cause of hyperosmolar hyperglycemic syndrome (HHS)?
A. Insulin overdose
B. Insulin deficiency with dehydration
C. Infection with hypoglycemia
D. Overhydration
✅ Correct Answer: B. Insulin deficiency with dehydration
Rationale: HHS occurs mainly in type 2 diabetics due to high glucose and severe dehydration without ketosis.
88. Which meal plan is best for a patient with diabetes?
A. Three large meals per day
B. Small, frequent balanced meals
C. One high-calorie meal per day
D. Skip breakfast and lunch
✅ Correct Answer: B. Small, frequent balanced meals
Rationale: Eating smaller, balanced meals throughout the day helps maintain stable glucose levels.
89. A diabetic patient is prescribed insulin glargine at bedtime. What is its primary advantage?
A. Rapid onset
B. No peak, long duration
C. Short half-life
D. Can be mixed with other insulins
✅ Correct Answer: B. No peak, long duration
Rationale: Glargine provides stable basal insulin coverage without peaks, reducing hypoglycemia risk.
90. Which electrolyte imbalance is often seen in DKA?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
✅ Correct Answer: A. Hyperkalemia
Rationale: Due to acidosis, potassium moves out of cells, causing temporary hyperkalemia.
91. A patient with type 1 diabetes is found unconscious. What should the nurse do first?
A. Give IV dextrose
B. Administer subcutaneous insulin
C. Call the physician
D. Check blood sugar before acting
✅ Correct Answer: A. Give IV dextrose
Rationale: Unconscious hypoglycemic patients cannot take oral glucose, so IV dextrose is given immediately.
92. A patient reports blurred vision and frequent urination. What should the nurse assess next?
A. Blood glucose level
B. Blood pressure
C. Temperature
D. Weight
✅ Correct Answer: A. Blood glucose level
Rationale: These are classic symptoms of hyperglycemia, requiring blood glucose assessment.
93. Which statement about insulin pens is correct?
A. They can be shared between family members
B. Needles should be changed with each use
C. Should be stored in a freezer
D. Air bubbles improve accuracy
✅ Correct Answer: B. Needles should be changed with each use
Rationale: Reusing or sharing insulin pens increases infection risk.
94. A nurse teaches sick-day rules to a diabetic patient. Which statement is correct?
A. “I will stop insulin when I can’t eat.”
B. “I will monitor glucose every 4 hours.”
C. “I should skip fluids to avoid vomiting.”
D. “I can ignore high readings when sick.”
✅ Correct Answer: B. I will monitor glucose every 4 hours
Rationale: During illness, glucose levels may fluctuate; frequent monitoring is crucial.
95. What is the best site for insulin injection with the fastest absorption?
A. Thigh
B. Upper arm
C. Abdomen
D. Buttocks
✅ Correct Answer: C. Abdomen
Rationale: The abdomen provides the fastest absorption due to high blood flow.
96. A diabetic patient develops lipodystrophy. What is the most likely cause?
A. Injection at the same site repeatedly
B. Insulin allergy
C. Using refrigerated insulin
D. Poor diet
✅ Correct Answer: A. Injection at the same site repeatedly
Rationale: Rotating injection sites prevents tissue damage or lipodystrophy.
97. What is the best time to administer regular insulin before meals?
A. Immediately after eating
B. 15–30 minutes before meals
C. 1 hour before meals
D. At bedtime
✅ Correct Answer: B. 15–30 minutes before meals
Rationale: Regular insulin has an onset of 30–60 minutes, aligning with meal glucose spikes.
98. Which symptom is most typical of hypoglycemia?
A. Warm, flushed skin
B. Sweating and palpitations
C. Dry mouth
D. Slow pulse
✅ Correct Answer: B. Sweating and palpitations
Rationale: These are sympathetic nervous system responses to low blood glucose.
99. A nurse is caring for a diabetic patient with foot ulcers. Which intervention is most appropriate?
A. Apply heat pads to improve circulation
B. Keep feet clean and dry
C. Massage feet daily
D. Use sharp scissors to trim calluses
✅ Correct Answer: B. Keep feet clean and dry
Rationale: Proper foot hygiene prevents infection and promotes healing.
100. What is the primary goal in diabetes management?
A. Complete cure
B. Maintain blood glucose within target range
C. Eliminate all carbohydrates
D. Stop insulin therapy
✅ Correct Answer: B. Maintain blood glucose within target range
Rationale: The main goal is stable glucose levels to prevent acute and chronic complications.
NCLEX Lab Values Practice Questions
NCLEX Fundamentals of Nursing Practice Test
🧠 Conclusion: Master Diabetes Management for NCLEX Success
Diabetes management is one of the most tested and high-yield topics on the NCLEX exam. Nurses must understand how to handle insulin administration, recognize hypoglycemia and hyperglycemia symptoms, and educate patients on long-term self-care practices like diet, exercise, and foot care. By mastering these NCLEX Diabetes Management Questions with rationales, you not only strengthen your exam preparation but also improve your ability to deliver safe, evidence-based patient care in real-world clinical settings.
Keep practicing consistently — the key to NCLEX success lies in repetition, rationale review, and critical thinking.