Insulin NCLEX-RN Practice Questions

Insulin NCLEX-RN Practice Questions

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Insulin NCLEX-RN Practice Questions

Mastering insulin therapy is essential for safe, effective nursing care across acute and community settings. This topic-wise practice set focuses on pharmacological and parenteral therapies related to insulin—covering pharmacokinetics, dosing strategies, safe mixing, storage, IV use, and clinical decision-making in complex scenarios like DKA, HHS, perioperative care, and pregnancy. Each question challenges your ability to apply evidence-based principles, anticipate adverse effects, educate patients, and prioritize interventions. Whether you are refining your understanding of rapid-acting vs. basal insulins, or preventing errors with concentrated formulations, these NCLEX-RN–level MCQs will help solidify critical competencies. Work through the questions to boost your confidence in insulin administration, monitoring, and patient teaching for optimal outcomes.

Q1. Which insulin has an onset of 10–15 minutes, a peak of about 1 hour, and a duration of 3–5 hours?

  • Insulin lispro
  • Regular insulin
  • NPH insulin
  • Insulin glargine

Correct Answer: Insulin lispro

Q2. A nurse prepares to mix NPH and regular insulin in the same syringe. Which technique is correct?

  • Inject air into NPH, inject air into regular, withdraw regular first, then withdraw NPH
  • Inject air into regular, inject air into NPH, withdraw NPH first, then withdraw regular
  • Withdraw NPH first to prevent contamination, then withdraw regular
  • Withdraw regular only and give NPH separately later

Correct Answer: Inject air into NPH, inject air into regular, withdraw regular first, then withdraw NPH

Q3. The provider orders insulin lispro for a patient before meals. When should the nurse administer the dose?

  • Thirty minutes before meals
  • Immediately after the meal is finished
  • When the meal tray is at the bedside and the patient is ready to eat
  • At bedtime regardless of meals

Correct Answer: When the meal tray is at the bedside and the patient is ready to eat

Q4. A conscious patient with type 1 diabetes reports shakiness and sweating; blood glucose is 58 mg/dL. What is the best initial action?

  • Give 4 ounces (120 mL) of orange juice and recheck blood glucose in 15 minutes
  • Administer 1 mg glucagon intramuscularly
  • Administer 25 g of 50% dextrose IV push
  • Hold food and notify the provider immediately

Correct Answer: Give 4 ounces (120 mL) of orange juice and recheck blood glucose in 15 minutes

Q5. A patient on a beta-blocker and insulin asks which hypoglycemia symptom is most likely to remain apparent. The nurse’s best response is:

  • Tremors
  • Palpitations
  • Diaphoresis
  • Anxiety

Correct Answer: Diaphoresis

Q6. Which statement about insulin storage indicates correct patient understanding?

  • I will keep an opened insulin vial at room temperature and discard it after 28 days
  • I will store all insulin in the freezer to prolong its shelf life
  • I will leave my insulin pen in the car for convenience
  • I will prefill syringes for three months and store them at room temperature

Correct Answer: I will keep an opened insulin vial at room temperature and discard it after 28 days

Q7. Which insulin is appropriate for intravenous administration in diabetic ketoacidosis (DKA)?

  • Insulin glargine
  • Insulin detemir
  • Regular human insulin
  • NPH insulin

Correct Answer: Regular human insulin

Q8. Which patient statement indicates correct understanding of insulin pump therapy?

  • The pump prevents all episodes of hyperglycemia so I do not need to check my blood sugar
  • I will remove the pump at night to avoid low blood sugars while sleeping
  • The pump delivers a continuous basal rate and I give bolus doses for meals; I will check my blood glucose frequently
  • I can mix my own insulin in the pump reservoir to save cost

Correct Answer: The pump delivers a continuous basal rate and I give bolus doses for meals; I will check my blood glucose frequently

Q9. Which teaching best supports consistent insulin absorption regarding injection sites?

  • Rotate between arms, thighs, and abdomen with each injection
  • Use one anatomical region for several days and rotate sites within that region at least 1 inch apart
  • Always inject into the thigh to reduce variability
  • Massage the site vigorously after each injection to enhance absorption

Correct Answer: Use one anatomical region for several days and rotate sites within that region at least 1 inch apart

Q10. A patient has elevated fasting blood glucose every morning. To differentiate dawn phenomenon from Somogyi effect, which action should the nurse take?

  • Check the patient’s blood glucose at 3:00 AM for several nights
  • Increase the patient’s bedtime snack
  • Hold the evening basal insulin dose
  • Administer a double dose of prandial insulin at dinner

Correct Answer: Check the patient’s blood glucose at 3:00 AM for several nights

Q11. A patient with type 2 diabetes starts high-dose prednisone for a COPD exacerbation. What is the nurse’s priority regarding insulin therapy?

  • Anticipate the need to increase insulin dosing and monitor glucose closely
  • Discontinue insulin to avoid hypoglycemia
  • Switch all insulin to NPH only
  • Reduce basal insulin and add bedtime alcohol to improve control

Correct Answer: Anticipate the need to increase insulin dosing and monitor glucose closely

Q12. A patient with long-standing diabetes develops stage 4 chronic kidney disease. How should insulin therapy be adjusted?

  • Increase insulin dose due to decreased renal function
  • Reduce insulin dose because insulin clearance is decreased
  • Switch to oral agents only
  • Stop basal insulin and give only sliding scale

Correct Answer: Reduce insulin dose because insulin clearance is decreased

Q13. Which statement about insulin compatibility is accurate?

  • Insulin glargine must not be mixed with any other insulin
  • Insulin glargine should be mixed with regular insulin to reduce injections
  • All basal insulins can be mixed with NPH
  • Insulin detemir should be mixed with lispro for meals

Correct Answer: Insulin glargine must not be mixed with any other insulin

Q14. Which is the safest approach when administering U-500 regular insulin?

  • Use a standard U-100 insulin syringe to simplify conversion
  • Use dedicated U-500 insulin syringes or a U-500 pen and perform independent double-checks
  • Draw up the dose in a tuberculin syringe for precision
  • Round doses to the nearest whole mL to reduce confusion

Correct Answer: Use dedicated U-500 insulin syringes or a U-500 pen and perform independent double-checks

Q15. The nurse prepares NPH insulin from a vial. What is the correct technique to resuspend the insulin?

  • Shake the vial vigorously for 30 seconds
  • Gently roll the vial between the palms until evenly cloudy
  • Warm the vial in hot water for 1 minute
  • Expose the vial to light briefly to dissolve clumps

Correct Answer: Gently roll the vial between the palms until evenly cloudy

Q16. The morning of surgery, a patient with diabetes is NPO. Which insulin action is appropriate?

  • Administer the full scheduled lispro dose
  • Hold the scheduled lispro dose because the patient is NPO
  • Hold all insulin to prevent hypoglycemia
  • Give extra NPH to cover surgical stress

Correct Answer: Hold the scheduled lispro dose because the patient is NPO

Q17. Before starting an insulin infusion for DKA, which laboratory parameter must be verified and corrected if necessary?

  • Serum potassium is at least 3.3 mEq/L
  • Serum sodium is above 150 mEq/L
  • Serum calcium is within normal limits
  • Urine output is greater than 100 mL/hr

Correct Answer: Serum potassium is at least 3.3 mEq/L

Q18. Which “sick day” instruction is correct for a patient using basal-bolus insulin?

  • Stop insulin when not eating to avoid hypoglycemia
  • Continue basal insulin, monitor glucose and ketones every 3–4 hours, and maintain hydration with carbohydrate-containing fluids
  • Double all insulin doses to control stress hyperglycemia
  • Check glucose once daily and resume usual dosing when feeling better

Correct Answer: Continue basal insulin, monitor glucose and ketones every 3–4 hours, and maintain hydration with carbohydrate-containing fluids

Q19. For the most consistent and rapid absorption of rapid-acting insulin, which site is preferred?

  • Subcutaneous tissue of the thigh
  • Subcutaneous tissue of the upper arm
  • Subcutaneous tissue of the abdomen, avoiding 2 inches around the umbilicus
  • Subcutaneous tissue of the buttocks

Correct Answer: Subcutaneous tissue of the abdomen, avoiding 2 inches around the umbilicus

Q20. Which patient is not an appropriate candidate for inhaled human insulin (Afrezza)?

  • A 25-year-old with no pulmonary history
  • A 62-year-old with chronic obstructive pulmonary disease
  • A 40-year-old with hypothyroidism
  • A 35-year-old with celiac disease

Correct Answer: A 62-year-old with chronic obstructive pulmonary disease

Q21. Which statement about insulin glargine teaching is accurate?

  • It should be taken only when blood glucose is above 200 mg/dL
  • It has a pronounced peak at 6–8 hours
  • It is taken at the same time each day to provide steady basal coverage without a peak
  • It must be mixed with regular insulin to be effective

Correct Answer: It is taken at the same time each day to provide steady basal coverage without a peak

Q22. Which inpatient order set best reflects a physiologic basal-bolus regimen?

  • NPH twice daily only
  • Sliding-scale regular insulin every 6 hours only
  • Insulin glargine once daily plus insulin lispro before meals with a correction scale
  • Regular insulin IV boluses as needed before meals

Correct Answer: Insulin glargine once daily plus insulin lispro before meals with a correction scale

Q23. What is the correct technique for subcutaneous insulin injection for a thin adult?

  • Use a 1.5 inch needle at a 90-degree angle
  • Use a short needle and inject at 45 to 90 degrees, pinching the skin if needed
  • Inject intramuscularly for faster absorption
  • Avoid pinching the skin and inject at 15 degrees

Correct Answer: Use a short needle and inject at 45 to 90 degrees, pinching the skin if needed

Q24. A hospitalized patient with diabetes is unconscious with a blood glucose of 32 mg/dL and no IV access. What is the priority intervention?

  • Administer 1 mg glucagon intramuscularly
  • Have the patient drink 8 ounces of juice
  • Wait for IV placement and then give 25 g D50 IV push
  • Place the patient in Trendelenburg position

Correct Answer: Administer 1 mg glucagon intramuscularly

Q25. An older adult with type 2 diabetes presents with HHS (glucose 780 mg/dL, no significant ketones). What is the initial priority?

  • Start an insulin infusion immediately
  • Begin large-volume isotonic fluid resuscitation and then start insulin
  • Give sodium bicarbonate IV
  • Restrict fluids to prevent cerebral edema

Correct Answer: Begin large-volume isotonic fluid resuscitation and then start insulin

Q26. Which teaching about insulin detemir is correct?

  • It should be mixed with lispro to provide basal-bolus coverage in one injection
  • It is a basal insulin given once or twice daily and should not be mixed with other insulins
  • It is given only intravenously for severe hyperglycemia
  • It has a rapid onset and should be injected with meals only

Correct Answer: It is a basal insulin given once or twice daily and should not be mixed with other insulins

Q27. What change in insulin needs is expected during the second and third trimesters of pregnancy?

  • Insulin requirements decrease steadily
  • Insulin requirements remain unchanged
  • Insulin requirements typically increase due to placental hormones
  • Insulin is discontinued and replaced by oral agents

Correct Answer: Insulin requirements typically increase due to placental hormones

Q28. Which counseling point about alcohol use and insulin is most appropriate?

  • Alcohol prevents hypoglycemia
  • Alcohol has no effect on glucose control
  • Alcohol increases the risk of delayed hypoglycemia; eat carbohydrates and monitor glucose
  • Drink alcohol on an empty stomach for better control

Correct Answer: Alcohol increases the risk of delayed hypoglycemia; eat carbohydrates and monitor glucose

Q29. Premeal blood glucose is 238 mg/dL. Orders: insulin lispro 5 units with meals plus correction scale (150–199 add 2 units; 200–249 add 4 units; 250–299 add 6 units; ≥300 add 8 units). What should the nurse administer now?

  • 5 units lispro
  • 4 units lispro
  • 9 units lispro
  • 6 units lispro

Correct Answer: 9 units lispro

Q30. During an injection assessment, the nurse notes lipohypertrophy on the patient’s abdomen. What is the best teaching point?

  • Continue injecting into the area to reduce pain
  • Avoid injecting into lipohypertrophied areas and rotate sites within one region to improve absorption
  • Massage the lumps daily to dissolve insulin deposits
  • Switch to intramuscular injections to “bypass” the area

Correct Answer: Avoid injecting into lipohypertrophied areas and rotate sites within one region to improve absorption

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