FLORIDA BOARD OF NURSING DIABETES
NURSING CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A nurse is assessing a patient with type 1 diabetes mellitus who
reports polyuria, polydipsia, nausea, abdominal discomfort, and
increasing fatigue. The patient has a blood glucose level of 428
mg/dL, respiratory rate of 30/min with deep respirations, and
fruity-smelling breath. Which additional finding most strongly
supports diabetic ketoacidosis (DKA)?
A. Serum bicarbonate of 28 mEq/L
B. Arterial pH of 7.50
C. Serum ketones and an elevated anion gap
D. Blood glucose of 110 mg/dL
Answer: C. Serum ketones and an elevated anion gap
Rationale: DKA is characterized by insulin deficiency leading to
hyperglycemia, ketone production, metabolic acidosis, and an
increased anion gap. Kussmaul respirations and fruity breath result
from compensatory respiratory elimination of carbon dioxide and
acetone production. A normal bicarbonate and alkalemia would not
support DKA.
2. A patient with type 1 diabetes mellitus is admitted with severe
DKA. The nurse receives an order to begin IV regular insulin. The
1
,patient's serum potassium is 2.8 mEq/L. What is the nurse's priority
action?
A. Begin the insulin infusion immediately
B. Administer potassium replacement before initiating insulin
C. Restrict IV fluids until potassium normalizes
D. Administer sodium bicarbonate immediately
Answer: B. Administer potassium replacement before initiating
insulin
Rationale: Although total-body potassium is depleted during DKA,
serum potassium may initially appear normal or elevated because
insulin deficiency and acidosis shift potassium extracellularly. When
the serum potassium is below 3.3 mEq/L, insulin can cause a rapid
intracellular shift and potentially precipitate life-threatening
hypokalemia and dysrhythmias. Potassium replacement takes priority
until the potassium is safely corrected.
3. A patient with type 2 diabetes mellitus takes metformin and is
scheduled for a radiologic study requiring iodinated contrast.
Which nursing consideration is most important?
A. Give the metformin immediately before contrast administration
B. Recognize that metformin may need to be withheld around contrast
exposure according to current renal-function and institutional protocols
C. Double the metformin dose after the procedure
D. Replace metformin permanently with insulin in every patient
receiving contrast
Answer: B. Recognize that metformin may need to be withheld
around contrast exposure according to current renal-function and
institutional protocols
2
,Rationale: Metformin is associated with a rare but serious risk of
lactic acidosis when significant renal dysfunction develops. Current
recommendations regarding withholding and restarting metformin
depend on kidney function, the type of contrast study, and institutional
protocol. The nurse should verify the patient's renal function and
follow the current order/protocol rather than automatically continuing
or permanently discontinuing therapy.
4. A patient with diabetes becomes confused, diaphoretic, tremulous,
and irritable. A bedside glucose reading is 48 mg/dL. The patient is
awake and able to swallow. What should the nurse do first?
A. Administer a rapid-acting carbohydrate
B. Administer long-acting insulin
C. Encourage the patient to ambulate
D. Give a high-fat meal immediately
Answer: A. Administer a rapid-acting carbohydrate
Rationale: A conscious patient with symptomatic hypoglycemia who
can safely swallow should receive approximately 15 g of fast-acting
carbohydrate, followed by reassessment of glucose after about 15
minutes and repeat treatment if necessary. High-fat foods delay
glucose absorption, while insulin would worsen hypoglycemia.
5. A patient with diabetes is unconscious and has a blood glucose
level of 32 mg/dL. There is no IV access. Which intervention is most
appropriate?
A. Give oral glucose gel
B. Administer glucagon according to the prescribed emergency protocol
C. Administer rapid-acting insulin
D. Give the patient water containing sugar by mouth
3
, Answer: B. Administer glucagon according to the prescribed
emergency protocol
Rationale: An unconscious patient should never receive food, liquid,
or oral medication because of aspiration risk. If IV access is
unavailable, glucagon can be administered according to the
appropriate emergency protocol. Once the patient regains
consciousness, ongoing glucose monitoring and carbohydrate
replacement are necessary.
6. Which finding is most characteristic of hyperosmolar
hyperglycemic state (HHS) rather than diabetic ketoacidosis?
A. Marked ketone production
B. Severe metabolic acidosis as the dominant feature
C. Profound hyperglycemia with significant dehydration and altered
mental status
D. Fruity breath caused by acetone
Answer: C. Profound hyperglycemia with significant dehydration
and altered mental status
Rationale: HHS typically occurs in patients with type 2 diabetes and is
characterized by extremely high glucose levels, profound dehydration,
increased serum osmolality, and varying degrees of neurologic
impairment. Ketosis and acidosis are usually absent or much less
prominent than in DKA.
7. A nurse is teaching a patient how to administer insulin glargine.
Which statement by the patient indicates correct understanding?
A. "I will mix glargine with regular insulin in the same syringe."
B. "I will use glargine as my long-acting basal insulin according to the
prescribed schedule."
4
NURSING CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A nurse is assessing a patient with type 1 diabetes mellitus who
reports polyuria, polydipsia, nausea, abdominal discomfort, and
increasing fatigue. The patient has a blood glucose level of 428
mg/dL, respiratory rate of 30/min with deep respirations, and
fruity-smelling breath. Which additional finding most strongly
supports diabetic ketoacidosis (DKA)?
A. Serum bicarbonate of 28 mEq/L
B. Arterial pH of 7.50
C. Serum ketones and an elevated anion gap
D. Blood glucose of 110 mg/dL
Answer: C. Serum ketones and an elevated anion gap
Rationale: DKA is characterized by insulin deficiency leading to
hyperglycemia, ketone production, metabolic acidosis, and an
increased anion gap. Kussmaul respirations and fruity breath result
from compensatory respiratory elimination of carbon dioxide and
acetone production. A normal bicarbonate and alkalemia would not
support DKA.
2. A patient with type 1 diabetes mellitus is admitted with severe
DKA. The nurse receives an order to begin IV regular insulin. The
1
,patient's serum potassium is 2.8 mEq/L. What is the nurse's priority
action?
A. Begin the insulin infusion immediately
B. Administer potassium replacement before initiating insulin
C. Restrict IV fluids until potassium normalizes
D. Administer sodium bicarbonate immediately
Answer: B. Administer potassium replacement before initiating
insulin
Rationale: Although total-body potassium is depleted during DKA,
serum potassium may initially appear normal or elevated because
insulin deficiency and acidosis shift potassium extracellularly. When
the serum potassium is below 3.3 mEq/L, insulin can cause a rapid
intracellular shift and potentially precipitate life-threatening
hypokalemia and dysrhythmias. Potassium replacement takes priority
until the potassium is safely corrected.
3. A patient with type 2 diabetes mellitus takes metformin and is
scheduled for a radiologic study requiring iodinated contrast.
Which nursing consideration is most important?
A. Give the metformin immediately before contrast administration
B. Recognize that metformin may need to be withheld around contrast
exposure according to current renal-function and institutional protocols
C. Double the metformin dose after the procedure
D. Replace metformin permanently with insulin in every patient
receiving contrast
Answer: B. Recognize that metformin may need to be withheld
around contrast exposure according to current renal-function and
institutional protocols
2
,Rationale: Metformin is associated with a rare but serious risk of
lactic acidosis when significant renal dysfunction develops. Current
recommendations regarding withholding and restarting metformin
depend on kidney function, the type of contrast study, and institutional
protocol. The nurse should verify the patient's renal function and
follow the current order/protocol rather than automatically continuing
or permanently discontinuing therapy.
4. A patient with diabetes becomes confused, diaphoretic, tremulous,
and irritable. A bedside glucose reading is 48 mg/dL. The patient is
awake and able to swallow. What should the nurse do first?
A. Administer a rapid-acting carbohydrate
B. Administer long-acting insulin
C. Encourage the patient to ambulate
D. Give a high-fat meal immediately
Answer: A. Administer a rapid-acting carbohydrate
Rationale: A conscious patient with symptomatic hypoglycemia who
can safely swallow should receive approximately 15 g of fast-acting
carbohydrate, followed by reassessment of glucose after about 15
minutes and repeat treatment if necessary. High-fat foods delay
glucose absorption, while insulin would worsen hypoglycemia.
5. A patient with diabetes is unconscious and has a blood glucose
level of 32 mg/dL. There is no IV access. Which intervention is most
appropriate?
A. Give oral glucose gel
B. Administer glucagon according to the prescribed emergency protocol
C. Administer rapid-acting insulin
D. Give the patient water containing sugar by mouth
3
, Answer: B. Administer glucagon according to the prescribed
emergency protocol
Rationale: An unconscious patient should never receive food, liquid,
or oral medication because of aspiration risk. If IV access is
unavailable, glucagon can be administered according to the
appropriate emergency protocol. Once the patient regains
consciousness, ongoing glucose monitoring and carbohydrate
replacement are necessary.
6. Which finding is most characteristic of hyperosmolar
hyperglycemic state (HHS) rather than diabetic ketoacidosis?
A. Marked ketone production
B. Severe metabolic acidosis as the dominant feature
C. Profound hyperglycemia with significant dehydration and altered
mental status
D. Fruity breath caused by acetone
Answer: C. Profound hyperglycemia with significant dehydration
and altered mental status
Rationale: HHS typically occurs in patients with type 2 diabetes and is
characterized by extremely high glucose levels, profound dehydration,
increased serum osmolality, and varying degrees of neurologic
impairment. Ketosis and acidosis are usually absent or much less
prominent than in DKA.
7. A nurse is teaching a patient how to administer insulin glargine.
Which statement by the patient indicates correct understanding?
A. "I will mix glargine with regular insulin in the same syringe."
B. "I will use glargine as my long-acting basal insulin according to the
prescribed schedule."
4
