NUR209 / NUR 209 Medical Surgical Nursing II Exam 2
ACTUAL PRACTICE EXAM 2026/2027 | Verified
Questions and Answers | Aligned to Fortis Curriculum &
NCLEX Style | Grade A Target | Pass Guaranteed
Section 1: Endocrine Disorders (Questions 1-15)
Q1: A 24-year-old patient with Type 1 diabetes presents to the ED with fruity breath, Kussmaul
respirations, and blood glucose of 480 mg/dL. Lab results show: pH 7.28, HCO3 18 mEq/L,
potassium 5.2 mEq/L. Which nursing intervention is the priority?
A. Administer regular insulin IV per protocol to lower blood glucose rapidly B. Begin 0.9% NS at
1 L/hr to restore volume and perfusion C. Check urine ketones and notify the provider of
moderate ketonuria D. Prepare to administer potassium supplements immediately
Correct Answer: B
Rationale: This patient presents with diabetic ketoacidosis (DKA) evidenced by hyperglycemia
(480 mg/dL), metabolic acidosis (pH 7.28, HCO3 18), and classic signs (fruity breath, Kussmaul
respirations). According to the American Diabetes Association 2024 Standards of Care and AACN
protocols, the priority in DKA management is fluid resuscitation with isotonic saline (0.9% NS) to
restore intravascular volume, improve perfusion, and begin correcting the osmotic diuresis.
Without adequate hydration, insulin cannot work effectively and may worsen hypotension.
While insulin is critical (Option A), it is not the first intervention—fluid resuscitation precedes
insulin therapy. Option C (checking ketones) is redundant as the clinical picture already confirms
DKA. Option D (potassium supplements) is premature and dangerous; while potassium will drop
with insulin administration, the initial potassium of 5.2 mEq/L is at the upper limit and
supplementation should only begin when levels fall below 5.0-5.5 mEq/L and urine output is
adequate.
Q2: A patient with Type 2 diabetes is prescribed metformin 1000 mg PO twice daily. Which
statement by the patient indicates understanding of safe medication administration?
A. "I should take this medication right before my meals to prevent stomach upset." B. "I need to
stop taking this medication 48 hours before any surgery or procedure using contrast dye." C. "If I
,miss a dose, I should double up on the next dose to maintain my blood sugar control." D. "I can
drink alcohol in moderation while taking metformin without any special precautions."
Correct Answer: B
Rationale: Metformin is contraindicated in patients with renal impairment and must be held
prior to iodinated contrast studies due to the risk of metformin-associated lactic acidosis
(MALA), particularly if contrast-induced nephropathy occurs. The 2024 ADA Standards of Care
and FDA labeling recommend discontinuing metformin at the time of or prior to the procedure
and withholding for 48 hours post-procedure, restarting only after renal function has been re-
evaluated and is stable. Option A is incorrect—metformin should be taken with meals (not right
before) to minimize GI side effects. Option C is incorrect—patients should never double doses;
they should take the missed dose with food unless it is almost time for the next dose. Option D
is incorrect—alcohol increases the risk of lactic acidosis and hypoglycemia; patients should
avoid excessive alcohol intake and never binge drink.
Q3: [SATA] A nurse is caring for a patient admitted with hyperthyroidism and Graves' disease.
Which assessment findings should the nurse expect? (Select all that apply.)
A. Bradycardia and hypotension B. Heat intolerance and diaphoresis C. Weight loss despite
increased appetite D. Lethargy and constipation E. Exophthalmos and lid lag F. Fine tremor of
the fingers
Correct Answers: B, C, E, F
Rationale: Hyperthyroidism involves excessive thyroid hormone production, increasing
metabolic rate and sympathetic nervous system activity. Expected findings include heat
intolerance and diaphoresis (B) due to increased thermogenesis; weight loss despite increased
appetite (C) due to hypermetabolism; ophthalmopathy including exophthalmos (protruding
eyes) and lid lag (E) characteristic of Graves' disease; and fine tremor (F) due to increased beta -
adrenergic activity. Options A (bradycardia, hypotension) and D (lethargy, constipation) are
classic signs of hypothyroidism (decreased metabolic state), not hyperthyroidism. Hyperthyroid
patients typically exhibit tachycardia, hypertension, anxiety, and diarrhea.
Q4: A patient with Addison's disease is admitted with acute adrenal crisis. Vital signs: BP 82/48,
HR 128, RR 24, Temp 99.8°F. Lab results: sodium 128 mEq/L, potassium 5.8 mEq/L, glucose 54
mg/dL. Which medication should the nurse prepare to administer first?
, A. Hydrocortisone 100 mg IV bolus B. Fludrocortisone 0.1 mg PO daily C. Regular insulin 10 units
IV push D. Kayexalate 15 g PO
Correct Answer: A
Rationale: Acute adrenal crisis is a life-threatening emergency requiring immediate
glucocorticoid replacement. Hydrocortisone 100 mg IV bolus is the priority because it provides
both glucocorticoid and mineralocorticoid activity, addressing hypotension, hyponatremia,
hyperkalemia, and hypoglycemia simultaneously. The Endocrine Society 2024 Clinical Practice
Guidelines and AACN protocols emphasize that hydrocortisone should precede fluid
resuscitation or other interventions. Fludrocortisone (B) is for chronic mineralocorticoid
replacement only and is not appropriate for acute crisis. Insulin (C) is contraindicated—
hypoglycemia is due to cortisol deficiency and will correct with hydrocortisone; insulin could
cause severe hypoglycemia. Kayexalate (D) is unnecessary as hyperkalemia will correct with
hydrocortisone and fluid resuscitation.
Q5: A patient with Cushing's syndrome is post-op following transsphenoidal hypophysectomy.
Which nursing intervention is the priority during the first 24 hours?
A. Monitor blood glucose every 4 hours and administer sliding scale insulin as needed B. Assess
for clear, watery drainage from the nose and test for glucose content C. Administer
hydrocortisone replacement therapy per protocol D. Monitor serum sodium levels every 6 hours
for signs of SIADH
Correct Answer: B
Rationale: The priority post-transsphenoidal surgery is detecting cerebrospinal fluid (CSF) leak,
which presents as clear, watery rhinorrhea (often described as "halo sign" on linen or positive
glucose on testing). CSF leak increases infection risk (meningitis) and requires immediate
neurosurgical notification. While all options are important, assessment for CSF leak (B) takes
priority for patient safety. Option A is important as hyperglycemia is common post-Cushing's
surgery, but not the immediate life-safety priority. Option C—hydrocortisone is given if the
patient develops adrenal insufficiency post-op, but is not automatic; it requires assessment.
Option D—SIADH is a risk, but diabetes insipidus (DI) is more common post-pituitary surgery
due to ADH disruption; monitoring urine output and specific gravity for DI is actually more
critical than sodium monitoring alone.
Q6: A patient with Type 1 diabetes has a blood glucose of 52 mg/dL and is alert but shaky and
diaphoretic. Which action should the nurse take first?
ACTUAL PRACTICE EXAM 2026/2027 | Verified
Questions and Answers | Aligned to Fortis Curriculum &
NCLEX Style | Grade A Target | Pass Guaranteed
Section 1: Endocrine Disorders (Questions 1-15)
Q1: A 24-year-old patient with Type 1 diabetes presents to the ED with fruity breath, Kussmaul
respirations, and blood glucose of 480 mg/dL. Lab results show: pH 7.28, HCO3 18 mEq/L,
potassium 5.2 mEq/L. Which nursing intervention is the priority?
A. Administer regular insulin IV per protocol to lower blood glucose rapidly B. Begin 0.9% NS at
1 L/hr to restore volume and perfusion C. Check urine ketones and notify the provider of
moderate ketonuria D. Prepare to administer potassium supplements immediately
Correct Answer: B
Rationale: This patient presents with diabetic ketoacidosis (DKA) evidenced by hyperglycemia
(480 mg/dL), metabolic acidosis (pH 7.28, HCO3 18), and classic signs (fruity breath, Kussmaul
respirations). According to the American Diabetes Association 2024 Standards of Care and AACN
protocols, the priority in DKA management is fluid resuscitation with isotonic saline (0.9% NS) to
restore intravascular volume, improve perfusion, and begin correcting the osmotic diuresis.
Without adequate hydration, insulin cannot work effectively and may worsen hypotension.
While insulin is critical (Option A), it is not the first intervention—fluid resuscitation precedes
insulin therapy. Option C (checking ketones) is redundant as the clinical picture already confirms
DKA. Option D (potassium supplements) is premature and dangerous; while potassium will drop
with insulin administration, the initial potassium of 5.2 mEq/L is at the upper limit and
supplementation should only begin when levels fall below 5.0-5.5 mEq/L and urine output is
adequate.
Q2: A patient with Type 2 diabetes is prescribed metformin 1000 mg PO twice daily. Which
statement by the patient indicates understanding of safe medication administration?
A. "I should take this medication right before my meals to prevent stomach upset." B. "I need to
stop taking this medication 48 hours before any surgery or procedure using contrast dye." C. "If I
,miss a dose, I should double up on the next dose to maintain my blood sugar control." D. "I can
drink alcohol in moderation while taking metformin without any special precautions."
Correct Answer: B
Rationale: Metformin is contraindicated in patients with renal impairment and must be held
prior to iodinated contrast studies due to the risk of metformin-associated lactic acidosis
(MALA), particularly if contrast-induced nephropathy occurs. The 2024 ADA Standards of Care
and FDA labeling recommend discontinuing metformin at the time of or prior to the procedure
and withholding for 48 hours post-procedure, restarting only after renal function has been re-
evaluated and is stable. Option A is incorrect—metformin should be taken with meals (not right
before) to minimize GI side effects. Option C is incorrect—patients should never double doses;
they should take the missed dose with food unless it is almost time for the next dose. Option D
is incorrect—alcohol increases the risk of lactic acidosis and hypoglycemia; patients should
avoid excessive alcohol intake and never binge drink.
Q3: [SATA] A nurse is caring for a patient admitted with hyperthyroidism and Graves' disease.
Which assessment findings should the nurse expect? (Select all that apply.)
A. Bradycardia and hypotension B. Heat intolerance and diaphoresis C. Weight loss despite
increased appetite D. Lethargy and constipation E. Exophthalmos and lid lag F. Fine tremor of
the fingers
Correct Answers: B, C, E, F
Rationale: Hyperthyroidism involves excessive thyroid hormone production, increasing
metabolic rate and sympathetic nervous system activity. Expected findings include heat
intolerance and diaphoresis (B) due to increased thermogenesis; weight loss despite increased
appetite (C) due to hypermetabolism; ophthalmopathy including exophthalmos (protruding
eyes) and lid lag (E) characteristic of Graves' disease; and fine tremor (F) due to increased beta -
adrenergic activity. Options A (bradycardia, hypotension) and D (lethargy, constipation) are
classic signs of hypothyroidism (decreased metabolic state), not hyperthyroidism. Hyperthyroid
patients typically exhibit tachycardia, hypertension, anxiety, and diarrhea.
Q4: A patient with Addison's disease is admitted with acute adrenal crisis. Vital signs: BP 82/48,
HR 128, RR 24, Temp 99.8°F. Lab results: sodium 128 mEq/L, potassium 5.8 mEq/L, glucose 54
mg/dL. Which medication should the nurse prepare to administer first?
, A. Hydrocortisone 100 mg IV bolus B. Fludrocortisone 0.1 mg PO daily C. Regular insulin 10 units
IV push D. Kayexalate 15 g PO
Correct Answer: A
Rationale: Acute adrenal crisis is a life-threatening emergency requiring immediate
glucocorticoid replacement. Hydrocortisone 100 mg IV bolus is the priority because it provides
both glucocorticoid and mineralocorticoid activity, addressing hypotension, hyponatremia,
hyperkalemia, and hypoglycemia simultaneously. The Endocrine Society 2024 Clinical Practice
Guidelines and AACN protocols emphasize that hydrocortisone should precede fluid
resuscitation or other interventions. Fludrocortisone (B) is for chronic mineralocorticoid
replacement only and is not appropriate for acute crisis. Insulin (C) is contraindicated—
hypoglycemia is due to cortisol deficiency and will correct with hydrocortisone; insulin could
cause severe hypoglycemia. Kayexalate (D) is unnecessary as hyperkalemia will correct with
hydrocortisone and fluid resuscitation.
Q5: A patient with Cushing's syndrome is post-op following transsphenoidal hypophysectomy.
Which nursing intervention is the priority during the first 24 hours?
A. Monitor blood glucose every 4 hours and administer sliding scale insulin as needed B. Assess
for clear, watery drainage from the nose and test for glucose content C. Administer
hydrocortisone replacement therapy per protocol D. Monitor serum sodium levels every 6 hours
for signs of SIADH
Correct Answer: B
Rationale: The priority post-transsphenoidal surgery is detecting cerebrospinal fluid (CSF) leak,
which presents as clear, watery rhinorrhea (often described as "halo sign" on linen or positive
glucose on testing). CSF leak increases infection risk (meningitis) and requires immediate
neurosurgical notification. While all options are important, assessment for CSF leak (B) takes
priority for patient safety. Option A is important as hyperglycemia is common post-Cushing's
surgery, but not the immediate life-safety priority. Option C—hydrocortisone is given if the
patient develops adrenal insufficiency post-op, but is not automatic; it requires assessment.
Option D—SIADH is a risk, but diabetes insipidus (DI) is more common post-pituitary surgery
due to ADH disruption; monitoring urine output and specific gravity for DI is actually more
critical than sodium monitoring alone.
Q6: A patient with Type 1 diabetes has a blood glucose of 52 mg/dL and is alert but shaky and
diaphoretic. Which action should the nurse take first?
