Managing glycemic control in hospitalized patients is a complex task due to factors like stress hyperglycemia, altered nutritional intake, and the use of medications like corticosteroids. This requires a shift away from oral agents to more precise and adaptable insulin regimens. As a key component of the Patient Care 5 curriculum, understanding the evidence-based protocols for basal-bolus therapy, IV insulin infusions, and the management of hyperglycemic crises is essential for ensuring patient safety. This quiz will test your knowledge on the principles and practices of inpatient glycemic management.
1. What is the recommended target blood glucose range for most critically ill and non-critically ill hospitalized patients?
- a. 70-110 mg/dL
- b. 110-140 mg/dL
- c. 140-180 mg/dL
- d. 200-250 mg/dL
Answer: c. 140-180 mg/dL
2. A “sliding scale” insulin (SSI) regimen is considered a(n) ____ approach to managing hyperglycemia.
- a. Proactive
- b. Reactive
- c. Basal
- d. Curative
Answer: b. Reactive
3. What is the preferred method for insulin therapy in a non-critically ill hospitalized patient who is eating regular meals?
- a. A scheduled basal-bolus-correctional subcutaneous insulin regimen.
- b. A sliding scale insulin regimen alone.
- c. An oral sulfonylurea.
- d. A continuous IV insulin infusion.
Answer: a. A scheduled basal-bolus-correctional subcutaneous insulin regimen.
4. The “bolus” component of a basal-bolus regimen is intended to cover:
- a. The patient’s baseline metabolic needs.
- b. The carbohydrates consumed in a meal (nutritional insulin).
- c. Only blood glucose levels above 200 mg/dL.
- d. The dawn phenomenon.
Answer: b. The carbohydrates consumed in a meal (nutritional insulin).
5. Why are most oral antidiabetic agents, like metformin and sulfonylureas, typically held upon hospital admission?
- a. They are not effective in the hospital.
- b. Due to risks associated with altered oral intake, changing renal function, and potential for side effects in acutely ill patients.
- c. They are too expensive for hospital use.
- d. They interact with all IV fluids.
Answer: b. Due to risks associated with altered oral intake, changing renal function, and potential for side effects in acutely ill patients.
6. The lecture “Management of Inpatient Hyperglycemia” is a specific topic in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. Which type of insulin is used for continuous IV insulin infusions?
- a. Insulin glargine
- b. NPH insulin
- c. Insulin aspart
- d. Regular insulin
Answer: d. Regular insulin
8. A patient is being transitioned from a continuous IV insulin infusion to a subcutaneous basal-bolus regimen. What is the most critical step to prevent rebound hyperglycemia?
- a. Stop the IV infusion 2-3 hours before giving the first subcutaneous dose.
- b. Administer the first dose of subcutaneous basal insulin 2-3 hours before stopping the IV infusion.
- c. Give the basal and bolus insulins at the same time the drip is stopped.
- d. Switch the patient to an oral agent immediately after stopping the drip.
Answer: b. Administer the first dose of subcutaneous basal insulin 2-3 hours before stopping the IV infusion.
9. Diabetic Ketoacidosis (DKA) is a hyperglycemic crisis characterized by hyperglycemia, ketosis, and:
- a. Metabolic alkalosis
- b. Anion gap metabolic acidosis
- c. A normal anion gap
- d. Respiratory acidosis
Answer: b. Anion gap metabolic acidosis
10. The three main pillars of initial DKA and HHS management are IV fluids, insulin therapy, and:
- a. Management of electrolyte abnormalities, especially potassium.
- b. Oral nutrition.
- c. A bolus of long-acting insulin.
- d. An oral antibiotic.
Answer: a. Management of electrolyte abnormalities, especially potassium.
11. The management of DKA/HHS is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. “Stress hyperglycemia” in a hospitalized patient is caused by:
- a. The patient worrying about their hospital bill.
- b. An underlying psychiatric condition.
- c. The release of counter-regulatory hormones like cortisol and catecholamines in response to acute illness.
- d. Poor nursing care.
Answer: c. The release of counter-regulatory hormones like cortisol and catecholamines in response to acute illness.
13. A patient on high-dose corticosteroid therapy (e.g., prednisone) will likely experience:
- a. Hypoglycemia
- b. Hyperglycemia
- c. No change in blood glucose
- d. Improved insulin sensitivity
Answer: b. Hyperglycemia
14. A “correctional” or “supplemental” insulin dose is given to:
- a. Cover the carbohydrates in a meal.
- b. Provide 24-hour background insulin coverage.
- c. Correct a blood glucose level that is above the target range.
- d. Prevent hypoglycemia.
Answer: c. Correct a blood glucose level that is above the target range.
15. Rationalizing the appropriate administration of injection medications is a key objective in the Hospital IPPE.
- a. True
- b. False
Answer: a. True
16. Hyperosmolar Hyperglycemic State (HHS) differs from DKA in that HHS typically presents with:
- a. Lower blood glucose levels and more severe acidosis.
- b. More rapid onset of symptoms.
- c. Profound hyperglycemia and dehydration with minimal to no ketosis.
- d. Its occurrence only in Type 1 Diabetes.
Answer: c. Profound hyperglycemia and dehydration with minimal to no ketosis.
17. The “Glycemic Control During Hospitalization” is a module within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
18. A patient is NPO (nothing by mouth) for a procedure. Which part of their insulin regimen should be held or adjusted?
- a. The basal insulin
- b. The correctional insulin
- c. The nutritional (bolus) insulin
- d. All insulin should be stopped.
Answer: c. The nutritional (bolus) insulin
19. A patient with DKA presents with a serum potassium of 5.5 mEq/L. However, their total body potassium is likely:
- a. High
- b. Normal
- c. Depleted, due to shifts and urinary losses.
- d. Impossible to determine.
Answer: c. Depleted, due to shifts and urinary losses.
20. An active learning session on diabetes is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A major safety goal of inpatient glycemic management is:
- a. To achieve an A1c of <6.5%.
- b. To prevent hypoglycemia.
- c. To use sliding scale insulin exclusively.
- d. To transition every patient to an insulin pump.
Answer: b. To prevent hypoglycemia.
22. Which of the following can precipitate DKA or HHS in a patient with diabetes?
- a. An infection (e.g., pneumonia, UTI)
- b. Non-adherence to insulin therapy
- c. An acute cardiovascular event like a myocardial infarction
- d. All of the above
Answer: d. All of the above.
23. A patient is receiving parenteral nutrition (PN). Their glycemic control should be managed with:
- a. An oral sulfonylurea.
- b. Metformin.
- c. A scheduled insulin regimen, either as a separate infusion or mixed in the PN bag.
- d. No insulin is needed as there is no oral intake.
Answer: c. A scheduled insulin regimen, either as a separate infusion or mixed in the PN bag.
24. An active learning session on diabetes is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A pharmacist’s role in inpatient glycemic management includes all of the following EXCEPT:
- a. Recommending an appropriate insulin regimen.
- b. Developing and managing IV insulin infusion protocols.
- c. Adjusting ventilator settings for respiratory compensation.
- d. Providing discharge counseling on insulin use.
Answer: c. Adjusting ventilator settings for respiratory compensation.
26. Why should the basal insulin dose be continued, perhaps at a reduced dose, even when a patient is NPO?
- a. To cover the meal they are not eating.
- b. To cover the body’s baseline glucose production from the liver.
- c. To prevent weight gain.
- d. It should always be stopped completely when NPO.
Answer: b. To cover the body’s baseline glucose production from the liver.
27. What is the initial fluid of choice for resuscitating a patient with DKA?
- a. D5W
- b. 0.45% NaCl
- c. 0.9% NaCl
- d. Lactated Ringer’s
Answer: c. 0.9% NaCl
28. An active learning session on diabetes is part of which course module?
- a. Module 2: Endocrinology
- b. Module 3: Women’s Health
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 2: Endocrinology
29. In a basal-bolus-correctional regimen, the correctional insulin is intended to:
- a. Lower a pre-meal blood glucose that is already at goal.
- b. Lower a pre-meal blood glucose that is above the goal range.
- c. Provide 24-hour background insulin coverage.
- d. Be given only at bedtime.
Answer: b. Lower a pre-meal blood glucose that is above the goal range.
30. The management of diabetes is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. A patient’s IV insulin drip is running at 5 units/hour. To transition them to subcutaneous basal insulin, a common starting point is:
- a. Calculate the total 24-hour IV dose and give 50-80% of that as the basal subcutaneous dose.
- b. Start with a fixed dose of 10 units of glargine.
- c. Give the same dose, 5 units, as a subcutaneous injection.
- d. Give half the hourly rate (2.5 units) as a basal dose.
Answer: a. Calculate the total 24-hour IV dose and give 50-80% of that as the basal subcutaneous dose.
32. The primary reason sliding scale insulin alone is discouraged is:
- a. It is too expensive.
- b. It leads to wide glycemic fluctuations and only treats hyperglycemia after it has already occurred.
- c. It has a high risk of DKA.
- d. It requires IV administration.
Answer: b. It leads to wide glycemic fluctuations and only treats hyperglycemia after it has already occurred.
33. Before administering IV insulin to a patient in DKA, which electrolyte must be checked and corrected if low?
- a. Sodium
- b. Calcium
- c. Potassium
- d. Phosphate
Answer: c. Potassium
34. What is the role of bicarbonate therapy in the management of most DKA cases?
- a. It is a first-line treatment for all patients with DKA.
- b. It is generally not recommended unless the arterial pH is severely low (e.g., <6.9).
- c. It is used to correct the hyperglycemia.
- d. It is used to treat the underlying infection.
Answer: b. It is generally not recommended unless the arterial pH is severely low (e.g., <6.9).
35. A “point-of-care” glucose test is performed:
- a. In the central laboratory.
- b. At the patient’s bedside.
- c. Once a day.
- d. By the pharmacist only.
Answer: b. At the patient’s bedside.
36. A patient is on continuous enteral nutrition (“tube feeds”). What is the best way to manage their insulin therapy?
- a. Sliding scale insulin only.
- b. A dose of rapid-acting insulin given three times a day.
- c. A scheduled dose of basal insulin, often combined with scheduled regular or rapid-acting insulin.
- d. Hold all insulin since the patient is not eating.
Answer: c. A scheduled dose of basal insulin, often combined with scheduled regular or rapid-acting insulin.
37. Hospital hyperglycemia, even in patients without a prior diagnosis of diabetes, is associated with:
- a. Better clinical outcomes.
- b. Shorter hospital stays.
- c. Worse clinical outcomes and increased risk of infection.
- d. No change in clinical outcomes.
Answer: c. Worse clinical outcomes and increased risk of infection.
38. The lecture “Management of DKA/HHS” is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
39. When a DKA patient’s blood glucose falls to ~200-250 mg/dL, what should be added to their IV fluids?
- a. Potassium
- b. Bicarbonate
- c. Dextrose
- d. Albumin
Answer: c. Dextrose
40. An active learning session covering glycemic control is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. Why is it important to have an institutional protocol for IV insulin infusions?
- a. To ensure safe and consistent management and reduce the risk of errors.
- b. To make the process more complicated for nurses.
- c. To increase the cost of care.
- d. It is not important.
Answer: a. To ensure safe and consistent management and reduce the risk of errors.
42. Which of the following insulins should NEVER be administered intravenously?
- a. Regular insulin
- b. Insulin aspart
- c. Insulin lispro
- d. Insulin glargine
Answer: d. Insulin glargine
43. A pharmacist’s role in inpatient glycemic control is crucial for:
- a. Preventing medication errors.
- b. Ensuring evidence-based therapy is used.
- c. Facilitating safe transitions of care.
- d. All of the above.
Answer: d. All of the above.
44. A patient’s correctional insulin is often referred to as their:
- a. Basal insulin
- b. Bolus insulin
- c. Sensitivity factor
- d. Mealtime insulin
Answer: c. Sensitivity factor
45. A patient is receiving prednisone 40 mg daily. The pharmacist should anticipate:
- a. A need to decrease the patient’s insulin doses.
- a. A need to increase the patient’s insulin doses, particularly for prandial coverage.
- c. A high risk of hypoglycemia.
- d. No effect on glycemic control.
Answer: b. A need to increase the patient’s insulin doses, particularly for prandial coverage.
46. Upon discharge, a patient who was managed on insulin in the hospital should receive:
- a. No follow-up instructions.
- b. A clear, reconciled medication list and comprehensive education on their discharge regimen.
- c. The same exact insulin regimen they were on in the hospital.
- d. A prescription for sliding scale insulin only.
Answer: b. A clear, reconciled medication list and comprehensive education on their discharge regimen.
47. “Hyperglycemic crisis” is a term that encompasses both DKA and HHS.
- a. True
- b. False
Answer: a. True
48. An active learning session on DKA and HHS is part of which course module?
- a. Module 2: Endocrinology
- b. Module 3: Women’s Health
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 2: Endocrinology
49. The overall management of inpatient hyperglycemia requires:
- a. A one-size-fits-all protocol.
- b. An individualized approach with frequent monitoring and adjustments.
- c. The use of oral agents only.
- d. A focus on treating only high blood sugars, not low ones.
Answer: b. An individualized approach with frequent monitoring and adjustments.
50. The ultimate goal of learning about inpatient glycemic control is to:
- a. Safely manage hyperglycemia while minimizing the risk of iatrogenic hypoglycemia to improve patient outcomes.
- b. Be able to manage an IV insulin drip without a protocol.
- c. Pass the endocrinology module.
- d. Ensure all hospitalized patients with diabetes have an A1c <7%.
Answer: a. Safely manage hyperglycemia while minimizing the risk of iatrogenic hypoglycemia to improve patient outcomes.