Sample stem for discussion. Not a scored item from your bank.
A 58-year-old with type 2 diabetes and hypertension reports two weeks of polyuria, polydipsia, and unintended weight loss. Random glucose in clinic is 342 mg/dL. BMI 31. No ketones on urinalysis. What is the best next step?
Correct answer: B. New hyperglycemia with classic symptoms needs confirmation and context before locking long-term therapy. A1c and renal function guide safe metformin use and urgency. Insulin may be needed later, but the stem does not show ketosis or acute crisis.
Why the other options fail
- A. Immediate insulin may be premature without full metabolic picture unless DKA or severe hyperglycemia is present.
- C. Diet alone with delayed follow-up is unsafe with symptomatic hyperglycemia.
- D. Starting metformin without renal assessment risks contraindication.
Clinical takeaway: NP items reward staged workup: confirm diagnosis, assess safety for meds, then align treatment to guidelines.