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RNC-IAP® Additional Practice Questions – Original Questions 1-
175 with Answers and Detailed Rationales UPDATED!!!
1. A 30-year-old woman at 32 weeks gestation with type 1
diabetes is admitted for glycemic control. She is on an
insulin pump. The nurse should:
A) Disconnect the pump and switch to sliding scale insulin
B) Continue the insulin pump and coordinate with the
diabetes educator
C) Stop all insulin until the provider evaluates
D) Administer glucagon to prevent hypoglycemia
Answer: B) Continue the insulin pump and coordinate with
the diabetes educator
Rationale: For a patient with an insulin pump who is
admitted, the pump should be continued if the patient is
alert and able to manage it, and hospital policy allows.
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Coordination with the diabetes educator or endocrine team
is essential. Disconnecting the pump abruptly can cause
hyperglycemia. Insulin should not be stopped. Glucagon is
for severe hypoglycemia, not routine use.
2. A 28-year-old woman at 30 weeks gestation with
gestational diabetes is started on insulin. The nurse should
teach her to:
A) Skip meals if her glucose is high
B) Rotate insulin injection sites and monitor for
hypoglycemia
C) Take insulin only when she feels symptoms
D) Stop insulin once glucose is controlled
Answer: B) Rotate insulin injection sites and monitor for
hypoglycemia
Rationale: Insulin therapy requires rotation of injection sites
to prevent lipohypertrophy and proper monitoring for
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hypoglycemia. Skipping meals can cause hypoglycemia.
Insulin should be taken as prescribed, not based on
symptoms alone, and should be continued throughout
pregnancy as needed.
3. A 32-year-old woman at 34 weeks gestation with
pregestational diabetes is admitted for poor glycemic
control. The nurse should monitor for which fetal
complication?
A) Microcephaly
B) Macrosomia and polyhydramnios
C) Intrauterine growth restriction
D) Oligohydramnios
Answer: B) Macrosomia and polyhydramnios
Rationale: Poor glycemic control in pregnancy leads to fetal
hyperinsulinemia, causing macrosomia (excessive growth)
and polyhydramnios (increased amniotic fluid from fetal
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polyuria). Microcephaly is not typical; IUGR is more common
with vascular disease. Oligohydramnios is not directly
related.
4. A 29-year-old woman at 31 weeks gestation with diet-
controlled gestational diabetes has a fasting glucose of 105
mg/dL. The next step is:
A) Continue diet therapy and recheck in 2 weeks
B) Initiate insulin therapy
C) Start metformin
D) No intervention needed
Answer: B) Initiate insulin therapy
Rationale: Fasting glucose >95 mg/dL in gestational
diabetes indicates the need for pharmacologic therapy.
Insulin is the preferred first-line medication. Metformin is an
alternative but not first-line. Continuing diet therapy alone is
insufficient when fasting glucose is elevated.
4|Page
RNC-IAP® Additional Practice Questions – Original Questions 1-
175 with Answers and Detailed Rationales UPDATED!!!
1. A 30-year-old woman at 32 weeks gestation with type 1
diabetes is admitted for glycemic control. She is on an
insulin pump. The nurse should:
A) Disconnect the pump and switch to sliding scale insulin
B) Continue the insulin pump and coordinate with the
diabetes educator
C) Stop all insulin until the provider evaluates
D) Administer glucagon to prevent hypoglycemia
Answer: B) Continue the insulin pump and coordinate with
the diabetes educator
Rationale: For a patient with an insulin pump who is
admitted, the pump should be continued if the patient is
alert and able to manage it, and hospital policy allows.
1|Page
, Page |2
Coordination with the diabetes educator or endocrine team
is essential. Disconnecting the pump abruptly can cause
hyperglycemia. Insulin should not be stopped. Glucagon is
for severe hypoglycemia, not routine use.
2. A 28-year-old woman at 30 weeks gestation with
gestational diabetes is started on insulin. The nurse should
teach her to:
A) Skip meals if her glucose is high
B) Rotate insulin injection sites and monitor for
hypoglycemia
C) Take insulin only when she feels symptoms
D) Stop insulin once glucose is controlled
Answer: B) Rotate insulin injection sites and monitor for
hypoglycemia
Rationale: Insulin therapy requires rotation of injection sites
to prevent lipohypertrophy and proper monitoring for
2|Page
, Page |3
hypoglycemia. Skipping meals can cause hypoglycemia.
Insulin should be taken as prescribed, not based on
symptoms alone, and should be continued throughout
pregnancy as needed.
3. A 32-year-old woman at 34 weeks gestation with
pregestational diabetes is admitted for poor glycemic
control. The nurse should monitor for which fetal
complication?
A) Microcephaly
B) Macrosomia and polyhydramnios
C) Intrauterine growth restriction
D) Oligohydramnios
Answer: B) Macrosomia and polyhydramnios
Rationale: Poor glycemic control in pregnancy leads to fetal
hyperinsulinemia, causing macrosomia (excessive growth)
and polyhydramnios (increased amniotic fluid from fetal
3|Page
, Page |4
polyuria). Microcephaly is not typical; IUGR is more common
with vascular disease. Oligohydramnios is not directly
related.
4. A 29-year-old woman at 31 weeks gestation with diet-
controlled gestational diabetes has a fasting glucose of 105
mg/dL. The next step is:
A) Continue diet therapy and recheck in 2 weeks
B) Initiate insulin therapy
C) Start metformin
D) No intervention needed
Answer: B) Initiate insulin therapy
Rationale: Fasting glucose >95 mg/dL in gestational
diabetes indicates the need for pharmacologic therapy.
Insulin is the preferred first-line medication. Metformin is an
alternative but not first-line. Continuing diet therapy alone is
insufficient when fasting glucose is elevated.
4|Page
