5 NCLEX-RN® Diabetes Questions to Add to Your List

• NCLEX-RN® diabetes questions should be a top area of focus. 
• Review the ins and outs of diabetes, then consider five questions that could come up on exam day. 
• Programs like Slone NCLEX provide these questions and more to help you succeed. 

One of the most complicated areas of nursing is endocrine. More specifically, diabetes. There seem to be so many ins and outs of diabetes that it’s easy to get lost and get the information twisted, while not missing the key need-to-know information missed.  

A few things to remember. Diabetes is a disease of blood sugar. When being tested over diabetes, you will get questions about safe medication administration, safe blood sugar ranges, patient assessments, symptoms, and interventions for hyper/hypoglycemia and DKA and HHS. Key things to remember when giving any medication or performing any intervention always ASSESS your patient first and then intervene/give the medication and then REASSESS.

This tells you if it is SAFE to perform that intervention/give that medication, and then you REASSESS to make sure your intervention worked/was effective, or if it worked too well.  

So, in diabetes, the big assessment is going to be blood sugar. Make sure you are assessing that blood sugar BEFORE any medication administration and then reassessing that blood sugar, especially if the client is showing signs of high or low blood sugars.  

Memory trick to remember hypoglycemia: TIRED – Tachycardia, Irritability, Restlessness, Excessively hungry, Diaphoresis – Think Hangry! 

Memory trick to remember hyperglycemia: 3 P’s, polydipsia (excessive thirst), polyphagia (excessive hunger), polyuria (excessive urination). 

So today we are going to refresh you on the need-to-know terms related to diabetes and give you five examples of what NCLEX-RN® diabetes questions could look like. 

Key Terms for NCLEX-RN® Diabetes Questions 

Diabetes Mellitus: A complex, chronic, and common disease of impaired nutrient metabolism, especially glucose, affecting the function of all body systems. 

Diabetic Ketoacidosis (DKA): A life-threatening diabetes complication, more commonly known as Type 1 diabetes mellitus, that is manifested by uncontrolled hyperglycemia, increased ketone production, and metabolic acidosis. 

Diabetic Peripheral Neuropathy: Progressive nerve function deterioration that causes loss of sensory perception, most commonly starting in the toes and feet of a diabetic patient. 

Gastroparesis: A chronic disease that causes delayed stomach emptying and can occur in people with diabetes when high blood sugar damages nerves in the stomach, slowing or stopping digestion. It’s a complication seen with long-term Type 1 and Type 2 diabetes.

Glucagon: A hormone that helps regulate blood sugar levels. It is produced by the pancreas and released into the bloodstream when blood glucose levels fall. Glucagon is important for maintaining a stable blood sugar level, which is vital for the body to function. When blood sugar levels are low, glucagon raises the blood sugar.  

Gluconeogenesis: The process of creating glucose from non-carbohydrate precursors, such as lactate, pyruvate, amino acids, and glycerol. It’s a metabolic process that occurs mainly in the liver and kidneys and is essential to maintain stable blood sugar levels. 

Glucose Regulation: Process maintaining the blood glucose levels within a stable range, despite changes in glucose intake and energy use.

Glycogenesis: Process of converting glucose into glycogen to be stored in the body. 

Glycogenolysis: Process of breaking down glycogen into glucose to produce energy.

Glycosylated hemoglobin (A1C): a standardized lab test that measures long-term blood sugar control. Normal is below 5.7%, prediabetes is 5.7%-6.4%, diabetes is 6.5% or higher. 

Hyperglycemia: Blood glucose above the normal range of 100. 

Hyperglycemic-Hyperosmolar State (HHS): A life-threatening complication of diabetes, most commonly Type 2 DM, that occurs when blood glucose levels remain too high for a long time. HHS is characterized by severe dehydration, hyperglycemia, and hyperosmolality, without significant ketoacidosis, which is seen in diabetic ketoacidosis. 

Hypoglycemia: Blood glucose lower than the normal range of 70.

Hyperinsulinemia: A chronic condition where the amount of insulin in the blood is higher than normal. Insulin is a hormone produced by the pancreas that helps regulate blood sugar. 

Ketogenesis: A metabolic process that converts the body’s fats to acid products (ketones), which are an alternative energy source for the body. 

Ketones: Abnormal acidic breakdown products that accumulate in the blood when insulin is unavailable, causing an acid-base imbalance leading to metabolic acidosis.

Kussmaul Respirations: Rapid, deep breathing patterns occur as the body responds to metabolic acidosis, often caused by diabetic ketoacidosis (DKA). The body tries to expel excess carbon dioxide through fast, deep breaths to correct the blood pH level. 

Lipolysis: A metabolic process that breaks down body fat to turn into glycerol and fatty acids.

Metabolic Syndrome: A simultaneous presence of multiple health conditions including hypertension, hyperglycemia, excess abdominal fat, and hyperlipidemia. When present together, they significantly increase the risk of developing heart disease, stroke, and Type 2 diabetes. Metabolic syndrome is linked to obesity and inactivity, and is characterized by insulin resistance where the body doesn’t use insulin effectively.

Proliferative Diabetic Retinopathy: A complication of diabetic retinopathy (DR) that occurs when new, abnormal blood vessels grow in the retina. These vessels are fragile and bleed easily causing the vision to be obscured. 

Proteolysis: Process of breaking down proteins into amino acids. 

Sample NCLEX-RN® Diabetes Questions 

Now that we have covered the basics, let’s bring it all together to see how it could be represented on your NCLEX® exam.  

1. The nurse is preparing to administer rapid-acting insulin to a client with diabetes mellitus type 1. Which of the following actions by the nurse is the priority? 

• Assessing the blood sugar. 
• Checking the client’s vital signs. 
• Getting a second nurse to check the insulin dose. 
• Rotating injection sites. 

2. The nurse recognizes that which of the following symptoms indicates the client’s blood sugar may be low? 

• Heart rate of 58. 
• Increased urine output. 
• The client is diaphoretic. 
• The client’s skin is dry and flushed. 

3. The nurse is assessing a client who presents to the emergency room with a blood glucose of 451; urine is positive for ketones, leukocytes, and protein; client has rapid deep respirations. The nurse anticipates the physician ordering which of the following order sets? 

• Hyperglycemic-hyperosmolar state treatment order set. 
• Hypoglycemia protocol order set.  
• Hyperglycemia protocol order set. 
• Diabetic ketoacidosis treatment order set. 

4. The nurse is providing education to a client newly diagnosed with diabetes type 2 who asks, “My doctor says I have metabolic syndrome and diabetes. What does that mean?” Which response by the nurse is appropriate? 

• “Having metabolic syndrome and diabetes places you at higher risk for cardiovascular disease and you will need to have good control of your blood sugar, blood pressure, and cholesterol to prevent complications.” 
• “It means that your body has a harder time eliminating drugs from the body so you will need to take lower doses of medication to prevent toxicities.” 
• “This means you will likely need insulin to manage your diabetes rather than oral antidiabetics.” 
• “Metabolic syndrome will help your body’s cells absorb insulin better to provide good blood glucose control.” 

5. The nurse educates the client on the manifestations of hyperglycemia. Which symptoms does the nurse include in their teaching? (Select all that apply) 

• Headache. 
• Increased urine output. 
• Tachycardia. 
• Increased thirst. 
• Diaphoresis. 
• Increased hunger. 

The correct answers to these questions are as follows: 

1. (A) Assessing the client’s blood sugar. The priority action by the nurse is to assess the client’s blood sugar. This determines if it is safe to administer the insulin to the client and is the highest priority to prevent harm. The other actions may be completed by the nurse, but they are not the priority. 
2. (C) The client is diaphoretic. Symptoms of hypoglycemia include tachycardia, irritability, restlessness, excessive hunger, and diaphoresis (remember TIRED). The other options are not correct and are not symptoms of hypoglycemia. 
3. (D) Diabetic ketoacidosis treatment order set. The client has symptoms indicating diabetic ketoacidosis, which includes hyperglycemia, metabolic acidosis, and increased production of ketones causing ketones in the urine. The other options are not correct. The client has ketones in the urine representing DKA, not HHS. Additionally, the client has high, not low, blood sugar, but the hyperglycemia protocol is not adequate to treat this client. 
4. (A) “Having metabolic syndrome and diabetes places you at higher risk for cardiovascular disease and you will need to have good control of your blood sugar, blood pressure, and cholesterol to prevent complications.” The correct teaching by the nurse would state that metabolic syndrome with diabetes increases the client’s risk for cardiovascular disease so the client will need to have good glucose, blood pressure, and cholesterol control. The other options are incorrect and not accurate teaching.
5. (B,D,F) Increased urine output, increased thirst, and increased hunger. The signs and symptoms of hyperglycemia are the 3 P’s polydipsia (increased thirst), polyphagia (increased hunger), and polyuria (increased urine output). 

The Bottom Line 

Now that you have successfully read through and answered all of these questions, you are that much closer and that much more prepared to take and pass the NCLEX®! Know that you’ve got this and that we’ve got you!

Begin your NCLEX® preparation journey with Slone NCLEX today.