Hypoglycemia and Hyperglycemia Emergencies Practice Questions
20 free Hypoglycemia and Hyperglycemia Emergencies practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which of the following signs indicate hypoglycemia?
- A Extreme thirst and frequent urination
- B Fruity breath and abdominal pain
- C Sweating, trembling, irritability
- D Blurred vision and possible ketones
Correct answer: Sweating, trembling, irritability
Sweating, trembling, and irritability are typical adrenergic symptoms of hypoglycemia.
What does the '15-15 rule' recommend for treating mild hypoglycemia?
- A Eat 15 grams of protein, wait 15 minutes, then recheck blood glucose
- B Inject 15 units of insulin, wait 15 minutes, then recheck blood glucose
- C Drink 15 mL of water, wait 15 minutes, then recheck blood glucose
- D Eat 15 g of carbohydrate, wait 15 minutes, then recheck glucose
Correct answer: Eat 15 g of carbohydrate, wait 15 minutes, then recheck glucose
The '15-15 rule' suggests eating 15 grams of carbohydrate, waiting 15 minutes, then rechecking blood glucose for mild hypoglycemia.
What is a key difference between hypoglycemia and hyperglycemia emergencies?
- A Hypoglycemia causes adrenergic signs; hyperglycemia causes polyuria, thirst and possible ketones
- B Both emergencies always present with fruity breath and rapid Kussmaul respirations
- C Neither emergency causes any change in level of consciousness or mental status
- D Hypoglycemia causes extreme thirst and polyuria; hyperglycemia causes sweating and trembling
Correct answer: Hypoglycemia causes adrenergic signs; hyperglycemia causes polyuria, thirst and possible ketones
Hypoglycemia often causes adrenergic symptoms while hyperglycemia presents with polyuria, thirst, and possible ketones.
Which pattern of findings indicates diabetic ketoacidosis (DKA), a hyperglycemia emergency?
- A Sweating, trembling, and irritability with low blood glucose
- B Normal glucose with isolated nausea and no other symptoms
- C High glucose, fruity breath, nausea, vomiting, and ketones
- D Mildly elevated glucose with no ketones and no symptoms
Correct answer: High glucose, fruity breath, nausea, vomiting, and ketones
DKA presents with markedly elevated glucose, fruity (acetone) breath, nausea, vomiting, and ketones from fat breakdown. Sweating and trembling with low glucose indicate hypoglycemia, not DKA.
What are the initial interventions in the emergency treatment of hyperglycemia (e.g., DKA or HHS)?
- A Oral carbohydrate intake only, then reassess in one hour
- B IV fluids, insulin, and electrolyte replacement
- C Immediate vigorous exercise to help lower the blood glucose
- D Withholding treatment until glucose exceeds 600 mg/dL
Correct answer: IV fluids, insulin, and electrolyte replacement
In hyperglycemia emergency care, initial interventions include aggressive IV fluids, insulin therapy, and electrolyte correction.
Which finding suggests hypoglycemia rather than hyperglycemia?
- A Dry, flushed skin and fruity breath
- B Trembling, palpitations, confusion
- C Polyuria and polydipsia
- D Ketones present in urine
Correct answer: Trembling, palpitations, confusion
Symptoms like trembling, palpitations, and confusion are characteristic of hypoglycemia, not hyperglycemia.
What should a nurse do for a patient with a rapid blood glucose of 45 mg/dL and unconsciousness?
- A Give oral glucose gel if able to swallow
- B Provide a large protein meal and wait for recovery
- C Administer intramuscular epinephrine immediately
- D Take no action since the patient appears to be asleep
Correct answer: Give oral glucose gel if able to swallow
For severe hypoglycemia with unconsciousness, if the patient can swallow, give fast-acting carbohydrate.
In hyperglycemia emergency care, monitoring which electrolyte is especially important owing to insulin therapy?
- A Calcium
- B Potassium
- C Magnesium
- D Phosphate
Correct answer: Potassium
Insulin therapy can lead to hypokalemia, so monitoring and replacing potassium is crucial in hyperglycemia cases.
Which scenario indicates a hyperglycemia emergency requiring immediate action?
- A Blood glucose 120 mg/dL, awake, no symptoms
- B Blood glucose 500 mg/dL, moderate polyuria, positive ketones
- C Blood glucose 85 mg/dL before exercise
- D Blood glucose 70 mg/dL with no symptoms
Correct answer: Blood glucose 500 mg/dL, moderate polyuria, positive ketones
A blood glucose of 500 mg/dL with ketones indicates a possible DKA episode, necessitating urgent treatment.
What is the best nursing teaching point for a patient who feels shaky and sweaty after skipping lunch following their usual insulin dose?
- A Skip the insulin dose next time to avoid the symptoms
- B Take carbohydrate or adjust insulin when a meal is delayed
- C Do nothing because the symptoms will resolve on their own
- D Treat symptoms only if blood glucose drops below 40 mg/dL
Correct answer: Take carbohydrate or adjust insulin when a meal is delayed
Teaching to adjust insulin dose or ensure carbohydrate intake is key to prevent hypoglycemia.
What is an early sign of diabetic ketoacidosis (DKA)?
- A Fruity breath, polyuria, and abdominal pain
- B Hypothermia, bradycardia, and cold clammy skin
- C Sweating and fine tremor without any thirst
- D Weight gain with peripheral edema and oliguria
Correct answer: Fruity breath, polyuria, and abdominal pain
Fruity breath, polyuria, and abdominal pain are early signs of DKA.
What is the best action for a patient with a blood glucose of 30 mg/dL, vomiting, and unconsciousness?
- A Give fruit juice by mouth right away
- B Administer IV dextrose, or IM glucagon if no IV access
- C Wait for the patient to regain consciousness on their own
- D Encourage the patient to sip plain water only
Correct answer: Administer IV dextrose, or IM glucagon if no IV access
Severe hypoglycemia with unconsciousness necessitates IV glucose or glucagon administration.
How does a 'hyperglycemic hyperosmolar state' (HHS) differ from DKA?
- A HHS is characterised mainly by marked ketosis and metabolic acidosis
- B HHS occurs in type 2 diabetes: severe hyperglycemia and profound dehydration, minimal ketosis
- C DKA occurs only in type 2 diabetes and never in type 1 diabetes
- D HHS resolves on its own and requires no fluid or insulin treatment
Correct answer: HHS occurs in type 2 diabetes: severe hyperglycemia and profound dehydration, minimal ketosis
HHS is commonly seen in type 2 diabetes with severe hyperglycemia, dehydration, and minimal ketosis, unlike DKA.
What is a correct teaching point for preventing hypoglycemia in insulin-treated patients?
- A Replacing fluid lowers glucose by dilution and restores perfusion
- B Fluids are unnecessary in DKA and only delay clinical recovery
- C IV fluids raise blood sugar further, so they should be avoided
- D Fluids have no meaningful role in the management of DKA
Correct answer: Replacing fluid lowers glucose by dilution and restores perfusion
Preventing hypoglycemia involves having fast-acting carbohydrate and monitoring glucose during changes in activity or insulin.
Why are IV fluids necessary in the treatment of DKA?
- A Blood glucose 120 mg/dL, awake, no symptoms reported
- B Blood glucose 500 mg/dL, polyuria, and positive ketones
- C Blood glucose 85 mg/dL just before planned exercise
- D Blood glucose 70 mg/dL, alert, and free of symptoms
Correct answer: Blood glucose 500 mg/dL, polyuria, and positive ketones
In DKA, IV fluids are essential to combat dehydration, restore volume, and dilute hyperglycemia.
Which sign suggests a patient with hypoglycemia is progressing to a critical stage?
- A Slight hunger with mild diaphoresis and warmth
- B Confusion, seizure, or loss of consciousness
- C Mild tremor with palpitations and slight anxiety
- D Slight fatigue with no other associated symptoms
Correct answer: Confusion, seizure, or loss of consciousness
Symptoms like confusion, seizures, or unconsciousness indicate severe hypoglycemia that needs urgent treatment.
At what blood glucose level should insulin treatment be initiated for hyperglycemia in hospitalized patients?
- A 120 mg/dL
- B 140 mg/dL
- C 180 mg/dL
- D 240 mg/dL
Correct answer: 180 mg/dL
In non-critically ill hospitalized patients, insulin therapy is often initiated when blood glucose exceeds 180 mg/dL.
What is the cause of adrenergic symptoms in hypoglycemia?
- A Falling glucose triggers adrenaline (catecholamine) release
- B An excess of glucagon secretion acting alone
- C Excess dietary carbohydrate intake at mealtimes
- D A complete lack of any counter-regulatory hormonal response
Correct answer: Falling glucose triggers adrenaline (catecholamine) release
Low glucose levels trigger counter-regulatory hormones, leading to adrenergic symptoms like palpitations, tremor, and sweating.
What does a glucose level of 290 mg/dL combined with moderate ketones in a patient with type 1 diabetes indicate?
- A It is mild and can safely wait until the next day
- B It may progress rapidly to DKA and needs prompt treatment
- C It is only hyperglycemia and poses no real danger
- D No monitoring of urine or blood ketones is needed
Correct answer: It may progress rapidly to DKA and needs prompt treatment
Elevated glucose levels and ketones in a patient with type 1 diabetes suggest a high risk of progressing to DKA, requiring immediate attention.
What is a correct teaching point for preventing hypoglycemia recurrence after an emergency?
- A Once glucose is above 70 mg/dL, no further food is required
- B Follow the initial carbohydrate with a carbohydrate-plus-protein snack
- C Avoid all protein-containing foods after a hypoglycemic episode
- D Resume the full insulin dose at once without rechecking glucose
Correct answer: Follow the initial carbohydrate with a carbohydrate-plus-protein snack
Following emergency treatment for hypoglycemia, consuming a snack with carbohydrate and protein helps prevent recurrence.