LPN Diabetes Care: Glucose and Insulin 4 — Questions and Answers
Question 1: A patient with diabetic ketoacidosis (DKA) is admitted. Which laboratory finding is most characteristic of this condition?
- Blood glucose > 250 mg/dL, pH < 7.3, positive serum ketones (Correct answer)
- Blood glucose 180 mg/dL, pH 7.38, negative serum ketones
- Sodium 128 mEq/L, glucose 90 mg/dL, pH 7.30
- Glucose > 600 mg/dL, pH 7.36, no ketones
Correct answer: Blood glucose > 250 mg/dL, pH < 7.3, positive serum ketones
DKA is defined by hyperglycemia (usually >250 mg/dL), metabolic acidosis (pH <7.3), and ketonemia/ketonuria; the last option describes hyperosmolar hyperglycemic state (HHS).
Question 2: When teaching a patient to perform self-monitoring of blood glucose (SMBG), which technique should the nurse emphasize?
- Use the side of the fingertip rather than the pad to reduce pain and get an adequate sample (Correct answer)
- Squeeze the fingertip firmly before lancing to ensure a large blood drop
- Wipe the first drop of blood away and use the second drop for testing
- Disinfect the site with alcohol and test immediately while still wet
Correct answer: Use the side of the fingertip rather than the pad to reduce pain and get an adequate sample
The lateral aspect of the fingertip is less sensitive and provides a good blood sample; testing while the site is still wet with alcohol can dilute the sample and give a falsely low reading.
Question 3: A type 2 diabetic patient is prescribed metformin. Which assessment finding would require the LPN to hold the medication and notify the provider?
- Serum creatinine of 2.4 mg/dL indicating significant renal impairment (Correct answer)
- Fasting blood glucose of 130 mg/dL
- HbA1c of 7.8%
- Blood pressure of 138/88 mmHg
Correct answer: Serum creatinine of 2.4 mg/dL indicating significant renal impairment
Metformin is contraindicated with significant renal impairment (eGFR <30 mL/min) due to the risk of lactic acidosis; an elevated creatinine signals reduced renal clearance.
Question 4: Which patient statement indicates a correct understanding of the Dawn phenomenon?
- 'My blood sugar rises in the early morning because of hormones released during sleep, not because I ate anything.' (Correct answer)
- 'My blood sugar goes low at night and then bounces up—that is why my morning reading is high.'
- 'Dawn phenomenon means my insulin stops working after midnight.'
- 'High morning glucose means I ate too many carbohydrates at dinner.'
Correct answer: 'My blood sugar rises in the early morning because of hormones released during sleep, not because I ate anything.'
The Dawn phenomenon results from early-morning surges in counter-regulatory hormones (cortisol, growth hormone) that raise hepatic glucose output without prior hypoglycemia.
Question 5: An LPN is caring for a patient receiving a continuous insulin infusion. The patient becomes pale, diaphoretic, and confused. Blood glucose reads 48 mg/dL. What is the immediate priority action?
- Stop the insulin infusion and notify the RN immediately (Correct answer)
- Decrease the infusion rate by half and recheck glucose in 30 minutes
- Document the finding and continue monitoring every 15 minutes
- Administer the next scheduled meal bolus to raise glucose
Correct answer: Stop the insulin infusion and notify the RN immediately
Severe symptomatic hypoglycemia in a patient on an IV insulin infusion requires immediately stopping the infusion and escalating to the RN for IV dextrose administration.
Question 6: A patient with type 1 diabetes develops nausea, vomiting, and inability to eat. Which sick-day rule should the nurse reinforce?
- Continue taking basal insulin and check blood glucose every 2–4 hours (Correct answer)
- Omit all insulin since the patient is not eating
- Double the insulin dose because illness raises blood glucose
- Only take insulin if blood glucose exceeds 300 mg/dL
Correct answer: Continue taking basal insulin and check blood glucose every 2–4 hours
Illness increases counter-regulatory hormones that raise glucose; basal insulin must be continued and glucose monitored frequently even when the patient cannot eat.
Question 7: Which site preparation technique is correct before subcutaneous insulin injection?
- Cleanse the site with an alcohol swab and allow it to dry completely before injecting (Correct answer)
- Rub the site vigorously with alcohol immediately before inserting the needle
- Apply a warm compress for 5 minutes to increase absorption speed
- Pinch the skin and inject at a 90-degree angle only in obese patients
Correct answer: Cleanse the site with an alcohol swab and allow it to dry completely before injecting
Allowing alcohol to dry prevents a stinging sensation and ensures it does not enter the subcutaneous tissue, which could irritate or degrade the insulin.
LPN Diabetes Care: Glucose and Insulin 4
A patient with diabetic ketoacidosis (DKA) is admitted.
Which laboratory finding is most characteristic of this condition?