QMA Insulin Hypoglycemia and Hyperglycemia 3 — Questions and Answers
Question 1: A resident receiving insulin therapy experiences shakiness and heart palpitations between meals. The QMA checks blood glucose and gets 65 mg/dL. Which food item is the BEST choice for immediate treatment?
- A sandwich with peanut butter
- 4 ounces of regular (non-diet) fruit juice (Correct answer)
- A diet soda
- A handful of nuts
Correct answer: 4 ounces of regular (non-diet) fruit juice
4 ounces of regular fruit juice provides approximately 15 grams of fast-acting carbohydrate, the recommended treatment for mild hypoglycemia.
Question 2: When should a QMA withhold an insulin dose and notify the nurse?
- When blood glucose is 140 mg/dL before a meal
- When blood glucose is below 70 mg/dL before administration (Correct answer)
- When the resident has just finished eating
- When blood glucose is 200 mg/dL
Correct answer: When blood glucose is below 70 mg/dL before administration
Administering insulin when blood glucose is already below 70 mg/dL could cause dangerous hypoglycemia; the nurse must be notified first.
Question 3: A diabetic resident becomes unresponsive and cannot swallow. The QMA suspects severe hypoglycemia. What is the CORRECT action?
- Pour juice slowly into the resident's mouth
- Administer glucagon if trained and authorized, and call for emergency help (Correct answer)
- Give an extra insulin dose to stabilize the glucose
- Place the resident in a seated position and monitor
Correct answer: Administer glucagon if trained and authorized, and call for emergency help
An unconscious resident cannot safely swallow; oral glucose is contraindicated, and glucagon or emergency services are required for severe hypoglycemia.
Question 4: Which of the following conditions increases a diabetic resident's risk of developing hypoglycemia?
- Eating a large carbohydrate-rich meal
- Decreased physical activity
- Excessive exercise without extra carbohydrate intake (Correct answer)
- High fat diet
Correct answer: Excessive exercise without extra carbohydrate intake
Exercise increases glucose uptake by muscles, which can rapidly lower blood glucose, especially if extra carbohydrates are not consumed beforehand.
Question 5: Diabetic ketoacidosis (DKA) is most commonly associated with which type of diabetes and blood sugar state?
- Type 2 diabetes with hypoglycemia
- Type 1 diabetes with hyperglycemia (Correct answer)
- Type 1 diabetes with hypoglycemia
- Type 2 diabetes with normal blood glucose
Correct answer: Type 1 diabetes with hyperglycemia
DKA occurs primarily in type 1 diabetes when insulin deficiency causes severe hyperglycemia and the breakdown of fat into ketones.
Question 6: A resident with diabetes tells the QMA they feel 'fine' but their pre-meal blood glucose is 285 mg/dL. The QMA should:
- Accept the resident's report and proceed without action
- Document the reading and report it to the nurse before administering insulin (Correct answer)
- Administer extra insulin to bring the level down faster
- Recheck in one hour without notifying anyone
Correct answer: Document the reading and report it to the nurse before administering insulin
A blood glucose of 285 mg/dL is significantly elevated and must be reported to the nurse, who will determine the appropriate insulin dose adjustment.
Question 7: Which of the following best describes the Somogyi effect in insulin management?
- Blood glucose rises steadily throughout the day due to missed doses
- Rebound hyperglycemia that occurs after nighttime hypoglycemia (Correct answer)
- A gradual decrease in insulin effectiveness over time
- High blood sugar caused by eating too many carbohydrates
Correct answer: Rebound hyperglycemia that occurs after nighttime hypoglycemia
The Somogyi effect is rebound hyperglycemia triggered by counter-regulatory hormones released in response to nighttime hypoglycemia.
QMA Insulin Hypoglycemia and Hyperglycemia 3
A resident receiving insulin therapy experiences shakiness and heart palpitations between meals.
The QMA checks blood glucose and gets 65 mg/dL.
Which food item is the BEST choice for immediate treatment?