Diabetes Protocol: Glycemic Control Quiz

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Patient Scenario

Mr. R., a 64-year-old male with type 2 diabetes, is admitted to a medical-surgical unit for
pneumonia. He is receiving basal insulin daily and prandial insulin with meals.

At 0700:
• Blood glucose: 92 mg/dL
• Patient reports poor appetite and states he “does not feel like eating breakfast”
• Meal tray arrives but remains untouched

At 0730:
• Prandial insulin is due

At 0830:
• Patient becomes diaphoretic, shaky, and reports dizziness
• Blood glucose recheck: 64 mg/dL

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NPD Brooklyn

United States

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Diabetes Protocol: Glycemic Control Quiz


Diabetes Protocol: Glycemic Control QuizOnline version Patient Scenario Mr. R., a 64-year-old male with type 2 diabetes, is admitted to a medical-surgical unit for pneumonia. He is receiving basal insulin daily and prandial insulin with meals. At 0700: • Blood glucose: 92 mg/dL • Patient reports poor appetite and states he “does not feel like eating breakfast” • Meal tray arrives but remains untouched At 0730: • Prandial insulin is due At 0830: • Patient becomes diaphoretic, shaky, and reports dizziness • Blood glucose recheck: 64 mg/dL by NPD Brooklyn 1 First and Last Name Written answer 2 Unit Written answer 3 1. How is hypoglycemia defined in the protocol? a B. BG <70 mg/dL or <100 mg/dL with symptoms b C. BG <90 mg/dL c A. BG <80 mg/dL d D. BG <100 mg/dL 4 2. What is the primary quality goal related to glycemic management in the hospital? a D. Avoid carbohydrate intake b C. Reduce risk of hypoglycemia and hyperglycemia c B. Eliminate insulin use d A. Maintain BG <140 mg/dL 5 3. Which is a symptom of hypoglycemia? a D. Headache b A. Increased thirst c B. Polyuria d C. Tremors 6 4. When should blood glucose be checked in relation to meals? a C. Only at bedtime b B. Before meals, as close to the meal as possible c A. 2 hours after meals d D. Every 6 hours 7 5. What should the nurse do before administering prandial insulin? a B. Confirm the patient will eat b D. Notify provider c C. Draw labs d A. Check vital signs 8 6. If a patient is not eating (NPO), what is appropriate? a B. Hold all insulin b C. Hold prandial insulin but continue basal insulin c D. Double correction dose d A. Give full prandial insulin 9 7. What is the first action when a patient’s BG is 64 mg/dL with symptoms? a A. Notify provider immediately without intervention b C. Treat hypoglycemia per protocol c B. Give insulin d D. Wait and recheck in 1 hour 10 8. How often should BG be rechecked after treating hypoglycemia? a D. Every hour b A. Every 5 minutes c B. Every 15 minutes d C. Every 30 minutes 11 9. What should be done once BG improves but the next meal is not soon? a A. Nothing b B. Give insulin c C. Provide carbohydrate and protein snack d D. Start IV fluids 12 10. Which action helps reduce hypoglycemic episodes? a D. Skip BG monitoring b C. Align insulin administration with nutrition intake c A. Administer insulin early to stay ahead d B. Always give insulin regardless of intake 13 Based on the patient scenario, what is the most probable primary diagnosis? a Gastroenteritis b Pneumonia c Acute myocardial infarction d Pulmonary embolism 14 Which initial action is most appropriate for this patient upon arrival to ED? a Administer aspirin 162-325 mg unless contraindicated b Obtain MRI brain c Initiate high-flow oxygen to 100% d Start IV antibiotics 15 Which vital sign finding would most support ischemia in this patient? a Elevated heart rate with crushing chest pain b Hyperglycemia only c Bradycardia with stable vitals d Normal BP with no pain 16 What is the most appropriate first diagnostic test? a CT angiography b Abdominal ultrasound c Liver function test d 12-lead ECG 17 Which lab value is most important to assess immediately? a ALT/AST b Troponin levels c BNP d Creatinine kinase 18 If ST-elevation is confirmed, what is the next major step? a Place patient on telemetry only b Start IV fluids for dehydration c Schedule observation overnight d Activate STEMI protocol for reperfusion 19 Which medication is typically avoided in acute MI with suspected right ventricle involvement? a Nitroglycerin if hypotensive b Aspirin c Heparin d Morphine 20 Which symptom would suggest possible heart failure as a complication to monitor? a Bibard/ basal crackles and peripheral edema b Headache with dizziness c Abdominal tenderness d Dry cough only 21 Which risk factor modification is essential for long-term management? a High-sodium diet only b Antibiotics daily c Antiplatelet therapy and statin therapy d Prolonged NSAID use 22 What is the key element of patient education before discharge? a Ignore mild symptoms b Recognize chest pain symptoms and seek immediate help c Self-dose adjust medications without contact d Wait 24 hours before seeking help Feedback 13 MI is most consistent with chest pain, diaphoresis, and ECG changes described in the scenario. 14 Aspirin reduces myocardial injury if not contraindicated. 15 Tachycardia with chest pain aligns with ischemic events. 16 ECG is the initial diagnostic test for suspected MI. 17 Troponin is a sensitive marker for myocardial injury. 18 Reperfusion therapy is indicated for STEMI promptly. 19 Right ventricular infarct can cause hypotension; nitrates may worsen it. 20 Pulmonary congestion and edema indicate heart failure. 21 Guideline-directed therapy reduces recurrent events. 22 Early recognition and timely medical attention improve outcomes.

Diabetes Protocol: Glycemic Control Quiz

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Diabetes Protocol: Glycemic Control QuizOnline version

by NPD Brooklyn

First and Last Name

Unit

1. How is hypoglycemia defined in the protocol?

2. What is the primary quality goal related to glycemic management in the hospital?

3. Which is a symptom of hypoglycemia?

4. When should blood glucose be checked in relation to meals?

5. What should the nurse do before administering prandial insulin?

6. If a patient is not eating (NPO), what is appropriate?

7. What is the first action when a patient’s BG is 64 mg/dL with symptoms?

8. How often should BG be rechecked after treating hypoglycemia?

9. What should be done once BG improves but the next meal is not soon?

10. Which action helps reduce hypoglycemic episodes?

Based on the patient scenario, what is the most probable primary diagnosis?

Which initial action is most appropriate for this patient upon arrival to ED?

Which vital sign finding would most support ischemia in this patient?

What is the most appropriate first diagnostic test?

Which lab value is most important to assess immediately?

If ST-elevation is confirmed, what is the next major step?

Which medication is typically avoided in acute MI with suspected right ventricle involvement?

Which symptom would suggest possible heart failure as a complication to monitor?

Which risk factor modification is essential for long-term management?

What is the key element of patient education before discharge?