Next-Gen NCLEX (NGN) Diabetes Practice Questions

by yaneenMarch 23, 20250 Comments

 

Next-Gen NCLEX (NGN) Diabetes Practice Questions

Below are case-based questions using different NGN formats.

Case Study Scenario:

Mr. Jameson, a 62-year-old male, presents to the ED with increased thirst, frequent urination, and fatigue for the past two days. He has a history of Type 2 Diabetes Mellitus (T2DM) and hypertension. His vital signs are:

  • BP: 138/85 mmHg

  • HR: 98 bpm

  • RR: 22 breaths/min

  • Temp: 99.1°F (37.3°C)

  • Blood Glucose: 435 mg/dL

  • Serum Ketones: Negative

  • BUN: 25 mg/dL (elevated)

  • Creatinine: 1.4 mg/dL (elevated)

1. Bow-Tie Question

Select the most likely cause, the priority nursing action, and the expected outcome.

  • Cause: (Select One)

    • ❏ Diabetic Ketoacidosis (DKA)

    • ❏ Hyperosmolar Hyperglycemic State (HHS)

    • ❏ Hypoglycemia

  • Priority Nursing Action: (Select One)

    • ❏ Administer IV insulin and fluids

    • ❏ Give oral glucose tablet

    • ❏ Encourage fluid intake and repeat glucose testing in 2 hours

  • Expected Outcome: (Select One)

    • ❏ Blood glucose stabilizes and urine output improves

    • ❏ Worsening ketonemia and metabolic acidosis

    • ❏ Increased risk for diabetic coma

Correct Answers:

✅ Cause: Hyperosmolar Hyperglycemic State (HHS)
✅ Priority Nursing Action: Administer IV insulin and fluids
✅ Expected Outcome: Blood glucose stabilizes and urine output improves

Rationale:

  • HHS occurs in Type 2 DM with extremely high blood glucose but no significant ketones.

  • Priority intervention: IV fluids to correct dehydration, then IV insulin to reduce blood glucose gradually.

  • Expected outcome: Improved hydration and glucose levels.

2. Matrix/Grid Question

Match the symptoms with either Hypoglycemia, DKA, or HHS.

SymptomHypoglycemiaDKAHHS
Blood glucose > 600 mg/dL❏❏❏
Kussmaul respirations❏❏❏
Sweating and tremors❏❏❏
Altered mental status❏❏❏

Correct Answers:

✅ Blood glucose > 600 mg/dL → HHS
✅ Kussmaul respirations → DKA
✅ Sweating and tremors → Hypoglycemia
✅ Altered mental status → HHS & Hypoglycemia

Rationale:

  • Hypoglycemia → Sweating, tremors, confusion, seizures.

  • DKA → Kussmaul respirations, ketones in urine, metabolic acidosis.

  • HHS → Very high glucose (>600 mg/dL), altered mental status, severe dehydration.

3. Drop-Down Question

A patient with Type 1 Diabetes is learning about insulin administration. Which statement requires further teaching?

❏ “I will rotate insulin injection sites within the same body area each week.”
❏ “If my blood sugar is 50 mg/dL, I will eat 15g of carbohydrates.”
❏ “I will mix long-acting and rapid-acting insulin in the same syringe.” ▼ (Select the correct response)

Correct Answer:

✅ “I will mix long-acting and rapid-acting insulin in the same syringe.”

Rationale:

  • Long-acting insulin (e.g., Glargine, Detemir) CANNOT be mixed with any other insulin.

  • Short-acting insulin (e.g., Regular) can be mixed with NPH insulin in the same syringe.

4. Highlight Text Question

Highlight the part of the patient teaching that needs correction.

“If I feel shaky and dizzy, I should take my insulin right away and check my blood sugar after 30 minutes. If my blood sugar is still low, I will eat a snack with high-fat content like peanut butter or cheese.”

Corrected Text:

“If I feel shaky and dizzy, I should eat 15g of carbohydrates right away and check my blood sugar after 15 minutes. If my blood sugar is still low, I will eat a snack with complex carbohydrates like whole-grain crackers or fruit.”

Rationale:

  • Hypoglycemia is treated with FAST-ACTING carbs (juice, glucose tabs, honey).

  • Fat delays glucose absorption and is NOT ideal for immediate treatment.

5. Trend Analysis Question

A 45-year-old patient with Type 2 Diabetes is hospitalized for an infection. Their blood glucose readings are:

TimeBlood Glucose (mg/dL)
0800240
1200290
1600345
2000380

What is the most appropriate nursing action?

❏ Administer sliding-scale insulin and monitor
❏ Encourage the patient to drink more fluids and recheck in 4 hours
❏ Call the healthcare provider to adjust insulin therapy

Correct Answer:

✅ Call the healthcare provider to adjust insulin therapy

Rationale:

  • Persistent hyperglycemia (glucose rising despite treatment) signals worsening insulin resistance.

  • The provider may need to adjust insulin regimen or start IV insulin in severe cases.

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