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NCLEX-RN Blood glucose monitoring practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Blood glucose monitoring sits inside the Reduction of Risk Potential category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Blood glucose monitoring sample questions

Question 1

A 62-year-old client with type 2 diabetes is 2 hours post-hip arthroplasty and reports feeling shaky and anxious. The nurse notes a heart rate of 98 beats per minute and a blood pressure of 118/76 mm Hg. The client's last insulin dose was 6 units of lispro given 3 hours ago with breakfast. Which action should the nurse take first?

  1. A Recheck the client's blood pressure in 15 minutes
  2. B Check the client's capillary blood glucose level now
  3. C Give the client 4 ounces of orange juice by mouth
  4. D Review the client's hemoglobin A1c result from admission
Show the answer and explanation

Correct answer: B

Shakiness, anxiety and tachycardia about 3 hours after rapid-acting insulin suggest hypoglycemia. A quick capillary glucose check confirms the problem and guides treatment, especially in a postoperative client who may not yet be allowed oral carbohydrates.

Why the other options are wrong:
A: Rechecking the blood pressure delays evaluating a possible glucose emergency.
C: When testing is quickly available, treatment follows confirmation, and oral intake may not be allowed yet after surgery.
D: A hemoglobin A1c reflects long-term control, not the current symptoms.

Question 2

A 62-year-old client with type 2 diabetes mellitus is postoperative day 1 after a colectomy. The nurse monitors blood glucose levels every 6 hours. At 1800, the blood glucose is 45 mg/dL. The client is awake and oriented, with a heart rate of 98/min and blood pressure 132/78 mm Hg. Which action should the nurse perform first?

  1. A Administer 1 mg intramuscular glucagon
  2. B Give 4 oz (120 mL) of orange juice orally
  3. C Start an intravenous bolus of 50% dextrose
  4. D Notify the provider immediately
Show the answer and explanation

Correct answer: B

For a conscious client with mild hypoglycemia (45 mg/dL), the first action is to give 15-20 grams of fast-acting oral carbohydrate, such as 4 oz of orange juice, per protocol. Intramuscular glucagon (the option "Administer 1 mg intramuscular glucagon" is reserved for unconscious clients or those unable to swallow. An IV bolus of 50% dextrose (the option "Start an intravenous bolus of 50% dextrose" is for clients with severe hypoglycemia or loss of consciousness. Notifying the provider (the option "Notify the provider immediately" is important but should follow the initial treatment to prevent further decline.

Question 3

A 68-year-old client with type 2 diabetes mellitus is admitted for management of a diabetic foot ulcer. The nurse checks the blood glucose level at 0730 and obtains a result of 58 mg/dL. The client is awake, alert, and denies any symptoms. What should the nurse do first?

  1. A Give 4 ounces (120 mL) of orange juice and recheck the blood glucose in 15 minutes.
  2. B Notify the provider and request an order for intravenous dextrose 50% 25 grams.
  3. C Administer 1 mg of glucagon intramuscularly and recheck glucose in 15 minutes.
  4. D Repeat the fingerstick using a different finger and a new test strip to confirm the result.
Show the answer and explanation

Correct answer: A

A glucose of 58 mg/dL is hypoglycemia even without symptoms. For an alert client who can swallow, the first treatment is about 15 grams of fast-acting carbohydrate, such as 4 ounces of juice, followed by a recheck in 15 minutes.

Why the other options are wrong:
B: IV dextrose is for clients who cannot swallow safely; this client can take oral carbohydrate right away.
C: Glucagon is for clients who are unconscious or cannot take anything by mouth.
D: Retesting first delays treatment; a value below 70 mg/dL should be treated promptly.

Question 4

A 65-year-old client with type 2 diabetes mellitus is admitted for elective knee replacement surgery. The client's blood glucose level is 245 mg/dL at 0600 on the morning of surgery. The nurse reviews the preoperative orders. Which action should the nurse take?

  1. A Notify the surgical team and request a sliding-scale insulin order
  2. B Administer the client's usual morning dose of metformin 850 mg orally
  3. C Hold all oral intake and give a glass of orange juice to lower the glucose
  4. D Proceed with the surgery as scheduled because the glucose is mildly elevated
Show the answer and explanation

Correct answer: A

A preoperative glucose of 245 mg/dL is above the usual perioperative target of under 180 mg/dL and raises the risk of infection and poor wound healing. The surgical team must be told so they can order insulin and decide whether to proceed.

Why the other options are wrong:
B: Metformin is usually held on the day of surgery because fasting and surgical stress increase the risk of lactic acidosis.
C: Orange juice raises blood glucose and also breaks the preoperative fasting order.
D: Proceeding without addressing the hyperglycemia ignores a correctable surgical risk.

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