Chapter 46 Management of Patients With
Diabetes | Comprehensive Nursing Study
Guide, Practice Questions & Exam Review
2026
Chapter 46: Management of Patients With Diabetes | Comprehensive Nursing
Study Guide
Practice Exam - 200 Questions
DOCUMENT OVERVIEW
• This comprehensive 200-question exam covers all essential aspects of diabetes
management in nursing practice, including pathophysiology, assessment,
medications, patient education, complications, and evidence-based interventions
across all diabetes types.
• Study this material by working through questions systematically, reviewing each
rationale thoroughly to build clinical reasoning skills and reinforce knowledge for
certification, licensure, or clinical competency assessments.
QUESTIONS
Question 1
A 45-year-old male patient is newly diagnosed with type 2 diabetes mellitus.
When educating the patient about the pathophysiology of his condition, the
nurse explains that type 2 diabetes is primarily characterized by which of the
following?
A) Complete destruction of beta cells in the pancreas
B) Insulin resistance and progressive beta cell dysfunction
C) Autoimmune destruction of pancreatic tissue
D) Excessive glucose production by the liver
E) Reduced kidney function leading to glucose retention
,CORRECT ANSWER: B) Insulin resistance and progressive beta cell dysfunction
Rationale: Type 2 diabetes mellitus is characterized by a combination of insulin
resistance (the body's cells do not respond adequately to insulin) and progressive
dysfunction of pancreatic beta cells, which eventually fail to produce sufficient
insulin. Unlike type 1 diabetes, which involves autoimmune destruction of beta
cells, type 2 develops gradually and is often associated with obesity and metabolic
syndrome. The patient's own insulin production is present but inadequate,
distinguishing it from type 1 diabetes where beta cells are completely destroyed.
Question 2
Which of the following laboratory values is diagnostic for diabetes mellitus
according to current ADA standards?
A) Fasting blood glucose of 100 mg/dL
B) Fasting blood glucose of 126 mg/dL or higher
C) Random blood glucose of 150 mg/dL
D) Hemoglobin A1C of 5.5%
E) Two-hour postprandial glucose of 160 mg/dL
CORRECT ANSWER: B) Fasting blood glucose of 126 mg/dL or higher
Rationale: According to the American Diabetes Association, a fasting blood glucose
level of 126 mg/dL or higher on at least two separate occasions is diagnostic for
diabetes mellitus. Fasting is defined as no caloric intake for at least 8 hours. A
fasting glucose of 100-125 mg/dL indicates impaired fasting glucose (prediabetes).
Other diagnostic criteria include a hemoglobin A1C of 6.5% or higher, or a 2-hour
plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test, or
random plasma glucose of 200 mg/dL or higher with symptoms of hyperglycemia.
Question 3
,A patient with type 1 diabetes is experiencing signs of diabetic ketoacidosis
(DKA). Which of the following is the most critical immediate intervention?
A) Administer regular insulin bolus
B) Start IV fluid replacement and continuous cardiac monitoring
C) Give oral glucose tablets
D) Instruct the patient to increase fluid intake
E) Provide high-protein nutrition
CORRECT ANSWER: B) Start IV fluid replacement and continuous cardiac
monitoring
Rationale: The most critical immediate intervention for a patient experiencing DKA
is to establish IV access and begin fluid replacement therapy with normal saline,
along with continuous cardiac monitoring. DKA is a life-threatening emergency
characterized by severe hyperglycemia, metabolic acidosis, and ketonemia. While
insulin will eventually be needed, immediate fluid replacement is essential to
correct severe dehydration and electrolyte imbalances that occur with DKA. The
patient's circulation must be restored before insulin is administered, as insulin can
cause dangerous shifts in potassium levels. Oral glucose is contraindicated in DKA.
Question 4
A 62-year-old woman with type 2 diabetes is prescribed metformin. The
patient asks the nurse why this medication is typically prescribed first. Which
response is most accurate?
A) Metformin rapidly lowers blood glucose levels
B) Metformin increases insulin secretion from the pancreas
C) Metformin reduces insulin resistance and decreases hepatic glucose production
D) Metformin prevents hypoglycemia in diabetes
E) Metformin promotes weight loss through increased calorie burning
, CORRECT ANSWER: C) Metformin reduces insulin resistance and decreases
hepatic glucose production
Rationale: Metformin is the first-line medication for type 2 diabetes because it
works through multiple beneficial mechanisms: it reduces insulin resistance in
peripheral tissues, decreases hepatic glucose production, and improves insulin
sensitivity. Unlike sulfonylureas, metformin does not increase insulin secretion and
therefore does not typically cause hypoglycemia when used alone. Metformin is
also associated with modest weight loss or weight neutrality, beneficial
cardiovascular effects, and is relatively inexpensive. It addresses the primary
pathophysiologic defect in type 2 diabetes—insulin resistance.
Question 5
A patient taking insulin glargine asks the nurse when this medication reaches
its peak effect. What is the most accurate response?
A) 30 minutes after injection
B) Insulin glargine has minimal peak; provides steady, consistent coverage
C) 2 hours after injection
D) 4-6 hours after injection
E) 12-14 hours after injection
CORRECT ANSWER: B) Insulin glargine has minimal peak; provides steady,
consistent coverage
Rationale: Insulin glargine is a long-acting (basal) insulin analog designed to
provide steady, relatively constant insulin levels throughout the day and night with
minimal peak activity. This 24-hour coverage mimics the body's baseline insulin
secretion. It is typically injected once daily and reaches steady state after 2-3 days
of dosing. This characteristic makes it ideal for providing basal coverage and
reducing the number of daily injections needed. Understanding the
pharmacokinetics of different insulin types is crucial for patient education and
preventing medication errors.
Diabetes | Comprehensive Nursing Study
Guide, Practice Questions & Exam Review
2026
Chapter 46: Management of Patients With Diabetes | Comprehensive Nursing
Study Guide
Practice Exam - 200 Questions
DOCUMENT OVERVIEW
• This comprehensive 200-question exam covers all essential aspects of diabetes
management in nursing practice, including pathophysiology, assessment,
medications, patient education, complications, and evidence-based interventions
across all diabetes types.
• Study this material by working through questions systematically, reviewing each
rationale thoroughly to build clinical reasoning skills and reinforce knowledge for
certification, licensure, or clinical competency assessments.
QUESTIONS
Question 1
A 45-year-old male patient is newly diagnosed with type 2 diabetes mellitus.
When educating the patient about the pathophysiology of his condition, the
nurse explains that type 2 diabetes is primarily characterized by which of the
following?
A) Complete destruction of beta cells in the pancreas
B) Insulin resistance and progressive beta cell dysfunction
C) Autoimmune destruction of pancreatic tissue
D) Excessive glucose production by the liver
E) Reduced kidney function leading to glucose retention
,CORRECT ANSWER: B) Insulin resistance and progressive beta cell dysfunction
Rationale: Type 2 diabetes mellitus is characterized by a combination of insulin
resistance (the body's cells do not respond adequately to insulin) and progressive
dysfunction of pancreatic beta cells, which eventually fail to produce sufficient
insulin. Unlike type 1 diabetes, which involves autoimmune destruction of beta
cells, type 2 develops gradually and is often associated with obesity and metabolic
syndrome. The patient's own insulin production is present but inadequate,
distinguishing it from type 1 diabetes where beta cells are completely destroyed.
Question 2
Which of the following laboratory values is diagnostic for diabetes mellitus
according to current ADA standards?
A) Fasting blood glucose of 100 mg/dL
B) Fasting blood glucose of 126 mg/dL or higher
C) Random blood glucose of 150 mg/dL
D) Hemoglobin A1C of 5.5%
E) Two-hour postprandial glucose of 160 mg/dL
CORRECT ANSWER: B) Fasting blood glucose of 126 mg/dL or higher
Rationale: According to the American Diabetes Association, a fasting blood glucose
level of 126 mg/dL or higher on at least two separate occasions is diagnostic for
diabetes mellitus. Fasting is defined as no caloric intake for at least 8 hours. A
fasting glucose of 100-125 mg/dL indicates impaired fasting glucose (prediabetes).
Other diagnostic criteria include a hemoglobin A1C of 6.5% or higher, or a 2-hour
plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test, or
random plasma glucose of 200 mg/dL or higher with symptoms of hyperglycemia.
Question 3
,A patient with type 1 diabetes is experiencing signs of diabetic ketoacidosis
(DKA). Which of the following is the most critical immediate intervention?
A) Administer regular insulin bolus
B) Start IV fluid replacement and continuous cardiac monitoring
C) Give oral glucose tablets
D) Instruct the patient to increase fluid intake
E) Provide high-protein nutrition
CORRECT ANSWER: B) Start IV fluid replacement and continuous cardiac
monitoring
Rationale: The most critical immediate intervention for a patient experiencing DKA
is to establish IV access and begin fluid replacement therapy with normal saline,
along with continuous cardiac monitoring. DKA is a life-threatening emergency
characterized by severe hyperglycemia, metabolic acidosis, and ketonemia. While
insulin will eventually be needed, immediate fluid replacement is essential to
correct severe dehydration and electrolyte imbalances that occur with DKA. The
patient's circulation must be restored before insulin is administered, as insulin can
cause dangerous shifts in potassium levels. Oral glucose is contraindicated in DKA.
Question 4
A 62-year-old woman with type 2 diabetes is prescribed metformin. The
patient asks the nurse why this medication is typically prescribed first. Which
response is most accurate?
A) Metformin rapidly lowers blood glucose levels
B) Metformin increases insulin secretion from the pancreas
C) Metformin reduces insulin resistance and decreases hepatic glucose production
D) Metformin prevents hypoglycemia in diabetes
E) Metformin promotes weight loss through increased calorie burning
, CORRECT ANSWER: C) Metformin reduces insulin resistance and decreases
hepatic glucose production
Rationale: Metformin is the first-line medication for type 2 diabetes because it
works through multiple beneficial mechanisms: it reduces insulin resistance in
peripheral tissues, decreases hepatic glucose production, and improves insulin
sensitivity. Unlike sulfonylureas, metformin does not increase insulin secretion and
therefore does not typically cause hypoglycemia when used alone. Metformin is
also associated with modest weight loss or weight neutrality, beneficial
cardiovascular effects, and is relatively inexpensive. It addresses the primary
pathophysiologic defect in type 2 diabetes—insulin resistance.
Question 5
A patient taking insulin glargine asks the nurse when this medication reaches
its peak effect. What is the most accurate response?
A) 30 minutes after injection
B) Insulin glargine has minimal peak; provides steady, consistent coverage
C) 2 hours after injection
D) 4-6 hours after injection
E) 12-14 hours after injection
CORRECT ANSWER: B) Insulin glargine has minimal peak; provides steady,
consistent coverage
Rationale: Insulin glargine is a long-acting (basal) insulin analog designed to
provide steady, relatively constant insulin levels throughout the day and night with
minimal peak activity. This 24-hour coverage mimics the body's baseline insulin
secretion. It is typically injected once daily and reaches steady state after 2-3 days
of dosing. This characteristic makes it ideal for providing basal coverage and
reducing the number of daily injections needed. Understanding the
pharmacokinetics of different insulin types is crucial for patient education and
preventing medication errors.
