LPN Diabetes Care: Glucose and Insulin 3 — Questions and Answers
Question 1: A patient with diabetes is NPO for a procedure. The provider orders to hold all oral antidiabetic agents. Which insulin type is MOST likely to still be administered?
- Basal (long-acting) insulin at a reduced dose (Correct answer)
- Rapid-acting insulin before each meal
- Regular insulin sliding scale with every meal
- No insulin of any type while the patient is NPO
Correct answer: Basal (long-acting) insulin at a reduced dose
Basal insulin maintains background glucose control even when the patient is fasting; rapid or meal-time insulin is withheld because there is no carbohydrate intake.
Question 2: A patient's HbA1c result is 9.2%. What does this indicate?
- Average blood glucose has been elevated over the past 2–3 months (Correct answer)
- The patient's blood glucose was high at the time of the blood draw only
- The patient is likely experiencing frequent hypoglycemic episodes
- The result is within normal limits for a person with diabetes
Correct answer: Average blood glucose has been elevated over the past 2–3 months
HbA1c reflects average plasma glucose over approximately 2–3 months; a value of 9.2% indicates persistent hyperglycemia well above the ADA target of <7%.
Question 3: Which of the following blood glucose values meets the ADA diagnostic criteria for diabetes mellitus?
- Fasting plasma glucose ≥ 126 mg/dL on two separate occasions (Correct answer)
- Random blood glucose of 140 mg/dL without symptoms
- Fasting plasma glucose of 110 mg/dL
- 2-hour OGTT glucose of 130 mg/dL
Correct answer: Fasting plasma glucose ≥ 126 mg/dL on two separate occasions
The ADA requires a fasting plasma glucose ≥126 mg/dL confirmed on two separate occasions (or once with symptoms) to diagnose diabetes.
Question 4: A patient with type 1 diabetes is found unresponsive with a blood glucose of 32 mg/dL. The LPN cannot establish IV access. What is the most appropriate next step?
- Administer glucagon intramuscularly per protocol (Correct answer)
- Apply oral glucose gel to the patient's gums
- Give orange juice through a straw
- Administer insulin to counteract the underlying problem
Correct answer: Administer glucagon intramuscularly per protocol
Glucagon IM is indicated for severe hypoglycemia in an unconscious patient when IV access is unavailable; oral glucose risks aspiration in an unresponsive patient.
Question 5: The nurse is preparing to administer insulin lispro (Humalog). When should this rapid-acting insulin be given relative to meals?
- 0–15 minutes before the meal or immediately after the first bite (Correct answer)
- 30–45 minutes before the meal
- 1 hour after the meal
- Only at bedtime regardless of meal schedule
Correct answer: 0–15 minutes before the meal or immediately after the first bite
Rapid-acting analogs like lispro have an onset of 10–15 minutes and should be given just before or with meals to match their action to carbohydrate absorption.
Question 6: A diabetic patient's Somogyi effect is suspected. Which assessment finding supports this?
- Elevated fasting glucose after documented nocturnal hypoglycemia (Correct answer)
- Steadily rising blood glucose throughout the entire day
- Normal fasting glucose with postprandial spikes only
- Low fasting glucose that remains low all morning
Correct answer: Elevated fasting glucose after documented nocturnal hypoglycemia
The Somogyi effect (rebound hyperglycemia) occurs when nocturnal hypoglycemia triggers counter-regulatory hormone release, causing a high morning glucose.
Question 7: Which foot-care instruction is most important for a patient with diabetic peripheral neuropathy?
- Inspect feet daily for cuts, blisters, and redness because sensation is reduced (Correct answer)
- Soak feet in hot water for 20 minutes each evening to improve circulation
- Cut toenails in a rounded shape to prevent ingrown nails
- Walk barefoot indoors to promote natural foot movement
Correct answer: Inspect feet daily for cuts, blisters, and redness because sensation is reduced
Reduced sensation means injuries go unnoticed; daily visual inspection is the cornerstone of diabetic foot care to catch problems early.
LPN Diabetes Care: Glucose and Insulin 3
A patient with diabetes is NPO for a procedure.
The provider orders to hold all oral antidiabetic agents.
Which insulin type is MOST likely to still be administered?