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 emergency department with
complaints of excessive thirst, polyuria, and abdominal pain for the past 2 days. Vital signs: BP
92/58 mmHg, HR 128 bpm, RR 32 breaths/min, temperature 99.1°F (37.3°C). Laboratory results
reveal: blood glucose 486 mg/dL, pH 7.28, HCO3 16 mEq/L, ketones present in urine, potassium
5.2 mEq/L. The nurse prepares to administer regular insulin per protocol. What is the priority
nursing intervention before initiating insulin therapy?
A. Administer IV potassium supplementation immediately
B. Obtain a 12-lead ECG to assess for cardiac arrhythmias
C. Ensure adequate IV fluid resuscitation with normal saline is initiated
D. Insert a nasogastric tube for gastric decompression
Correct Answer: C
Rationale: The patient presents with diabetic ketoacidosis (DKA) characterized by
hyperglycemia (486 mg/dL), metabolic acidosis (pH 7.28, HCO3 16 mEq/L), and ketonuria. While
insulin therapy is essential for treating DKA, the priority intervention is fluid resuscitation with
isotonic saline (0.9% NaCl) before or simultaneously with insulin administration. According to
the American Diabetes Association (ADA) Standards of Medical Care in Diabetes 2024, initial
fluid resuscitation (15-20 mL/kg/hour in the first hour) restores intravascular volume, improves
perfusion, and begins to lower blood glucose through dilution and improved renal perfusion.
Insulin administration without adequate hydration can cause rapid intracellular shifts of glucose
and water, potentially worsening hypotension and cardiovascular collapse. Option A is incorrect
because while potassium will eventually need replacement (insulin drives potassium
intracellularly), the initial potassium of 5.2 mEq/L is at the upper limit of normal and doesn't
require immediate supplementation before fluids. Option B is important but not the priority—
ECG monitoring is ongoing. Option D is unnecessary unless there is gastric dilation or ileus.
[CORRECT: C]
,Q2: A 58-year-old patient with Type 2 diabetes is admitted for uncontrolled hyperglycemia. The
nurse is reviewing the physician's orders for insulin therapy. Which statement by the nurse
indicates correct understanding of basal-bolus insulin therapy?
A. "Basal insulin controls postprandial glucose spikes, while bolus insulin maintains background
glucose control."
B. "Basal insulin mimics the pancreas's continuous low-level secretion, and bolus insulin covers
mealtime carbohydrates." [CORRECT]
C. "Bolus insulin is given only at bedtime to prevent dawn phenomenon."
D. "Basal insulin is held if the patient is NPO, but bolus insulin is always given regardless of
intake."
Correct Answer: B
Rationale: Basal-bolus insulin therapy is designed to mimic physiological insulin secretion. Basal
insulin (glargine, detemir, degludec, or NPH) provides continuous background insulin to
suppress hepatic glucose production and maintain glucose control between meals and
overnight. Bolus (prandial) insulin (rapid-acting: lispro, aspart, glulisine; short-acting: regular) is
given to cover carbohydrate intake at meals and correct hyperglycemia. Option A reverses these
functions. Option C incorrectly describes bolus insulin timing—it's given with meals, not just at
bedtime. Option D is unsafe—bolus insulin should be held or adjusted when patients are NPO to
prevent hypoglycemia, while basal insulin is typically continued at a reduced dose (usually 75-
80% of home dose) to prevent ketosis. [CORRECT: B]
Q3: A patient with Graves' disease is started on methimazole (Tapazole). The nurse provides
discharge education. Which patient statement indicates a need for further teaching?
A. "I should report any sore throat, fever, or unusual bleeding immediately."
B. "I will take this medication at the same time every day to maintain consistent levels."
C. "If I miss a dose, I should double up on the next dose to maintain therapeutic levels."
[CORRECT]
D. "I understand that my thyroid function tests will need to be monitored regularly."
Correct Answer: C
Rationale: Methimazole is an antithyroid medication that inhibits thyroid hormone synthesis.
Never double doses of antithyroid medications—if a dose is missed, it should be taken as soon
as remembered unless it's close to the next scheduled dose, in which case skip the missed dose.
Doubling doses increases the risk of agranulocytosis (potentially fatal drop in white blood cells),
, hepatotoxicity, and other adverse effects. Option A is correct—patients must report signs of
agranulocytosis (sore throat, fever, malaise) or thrombocytopenia (bleeding) immediately.
Option B demonstrates proper adherence. Option D shows understanding of necessary
monitoring (TSH, free T4 every 4-6 weeks until euthyroid, then every 2-3 months). [CORRECT: C]
Q4: [SATA] A nurse is caring for a patient admitted with hyperosmolar hyperglycemic state
(HHS). Which assessment findings are consistent with this diagnosis? (Select all that apply.)
A. Blood glucose 850 mg/dL [CORRECT]
B. Arterial pH 7.25
C. Serum osmolality 340 mOsm/kg [CORRECT]
D. Altered mental status [CORRECT]
E. Positive serum ketones
F. Kussmaul respirations
Correct Answer: A, C, D
Rationale: HHS is characterized by severe hyperglycemia (typically >600 mg/dL, often 800-1200
mg/dL), hyperosmolality (>320 mOsm/kg, typically 330-380 mOsm/kg), and altered mental
status (confusion to coma) without significant ketosis or acidosis. The pathophysiology involves
profound dehydration and osmotic diuresis without the ketone production seen in DKA. Option
B (pH 7.25) indicates acidosis typical of DKA; HHS patients usually have pH >7.3. Option E
(positive ketones) is characteristic of DKA; HHS shows minimal or absent ketonemia/ketonuria.
Option F (Kussmaul respirations—deep, rapid breathing) is a compensatory mechanism for
metabolic acidosis in DKA, not HHS. [CORRECT: A, C, D]
Q5: A patient with Addison's disease is admitted with acute adrenal crisis. Vital signs: BP 78/52
mmHg, HR 132 bpm, RR 24 breaths/min, temperature 99.8°F (37.7°C). Laboratory results:
sodium 128 mEq/L, potassium 5.9 mEq/L, glucose 54 mg/dL. Which medication should the
nurse prepare to administer first?
A. Oral hydrocortisone 20 mg
B. IV hydrocortisone 100 mg bolus [CORRECT]
C. IV insulin and dextrose to treat hyperkalemia
D. Oral fludrocortisone 0.1 mg
Correct Answer: B
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 emergency department with
complaints of excessive thirst, polyuria, and abdominal pain for the past 2 days. Vital signs: BP
92/58 mmHg, HR 128 bpm, RR 32 breaths/min, temperature 99.1°F (37.3°C). Laboratory results
reveal: blood glucose 486 mg/dL, pH 7.28, HCO3 16 mEq/L, ketones present in urine, potassium
5.2 mEq/L. The nurse prepares to administer regular insulin per protocol. What is the priority
nursing intervention before initiating insulin therapy?
A. Administer IV potassium supplementation immediately
B. Obtain a 12-lead ECG to assess for cardiac arrhythmias
C. Ensure adequate IV fluid resuscitation with normal saline is initiated
D. Insert a nasogastric tube for gastric decompression
Correct Answer: C
Rationale: The patient presents with diabetic ketoacidosis (DKA) characterized by
hyperglycemia (486 mg/dL), metabolic acidosis (pH 7.28, HCO3 16 mEq/L), and ketonuria. While
insulin therapy is essential for treating DKA, the priority intervention is fluid resuscitation with
isotonic saline (0.9% NaCl) before or simultaneously with insulin administration. According to
the American Diabetes Association (ADA) Standards of Medical Care in Diabetes 2024, initial
fluid resuscitation (15-20 mL/kg/hour in the first hour) restores intravascular volume, improves
perfusion, and begins to lower blood glucose through dilution and improved renal perfusion.
Insulin administration without adequate hydration can cause rapid intracellular shifts of glucose
and water, potentially worsening hypotension and cardiovascular collapse. Option A is incorrect
because while potassium will eventually need replacement (insulin drives potassium
intracellularly), the initial potassium of 5.2 mEq/L is at the upper limit of normal and doesn't
require immediate supplementation before fluids. Option B is important but not the priority—
ECG monitoring is ongoing. Option D is unnecessary unless there is gastric dilation or ileus.
[CORRECT: C]
,Q2: A 58-year-old patient with Type 2 diabetes is admitted for uncontrolled hyperglycemia. The
nurse is reviewing the physician's orders for insulin therapy. Which statement by the nurse
indicates correct understanding of basal-bolus insulin therapy?
A. "Basal insulin controls postprandial glucose spikes, while bolus insulin maintains background
glucose control."
B. "Basal insulin mimics the pancreas's continuous low-level secretion, and bolus insulin covers
mealtime carbohydrates." [CORRECT]
C. "Bolus insulin is given only at bedtime to prevent dawn phenomenon."
D. "Basal insulin is held if the patient is NPO, but bolus insulin is always given regardless of
intake."
Correct Answer: B
Rationale: Basal-bolus insulin therapy is designed to mimic physiological insulin secretion. Basal
insulin (glargine, detemir, degludec, or NPH) provides continuous background insulin to
suppress hepatic glucose production and maintain glucose control between meals and
overnight. Bolus (prandial) insulin (rapid-acting: lispro, aspart, glulisine; short-acting: regular) is
given to cover carbohydrate intake at meals and correct hyperglycemia. Option A reverses these
functions. Option C incorrectly describes bolus insulin timing—it's given with meals, not just at
bedtime. Option D is unsafe—bolus insulin should be held or adjusted when patients are NPO to
prevent hypoglycemia, while basal insulin is typically continued at a reduced dose (usually 75-
80% of home dose) to prevent ketosis. [CORRECT: B]
Q3: A patient with Graves' disease is started on methimazole (Tapazole). The nurse provides
discharge education. Which patient statement indicates a need for further teaching?
A. "I should report any sore throat, fever, or unusual bleeding immediately."
B. "I will take this medication at the same time every day to maintain consistent levels."
C. "If I miss a dose, I should double up on the next dose to maintain therapeutic levels."
[CORRECT]
D. "I understand that my thyroid function tests will need to be monitored regularly."
Correct Answer: C
Rationale: Methimazole is an antithyroid medication that inhibits thyroid hormone synthesis.
Never double doses of antithyroid medications—if a dose is missed, it should be taken as soon
as remembered unless it's close to the next scheduled dose, in which case skip the missed dose.
Doubling doses increases the risk of agranulocytosis (potentially fatal drop in white blood cells),
, hepatotoxicity, and other adverse effects. Option A is correct—patients must report signs of
agranulocytosis (sore throat, fever, malaise) or thrombocytopenia (bleeding) immediately.
Option B demonstrates proper adherence. Option D shows understanding of necessary
monitoring (TSH, free T4 every 4-6 weeks until euthyroid, then every 2-3 months). [CORRECT: C]
Q4: [SATA] A nurse is caring for a patient admitted with hyperosmolar hyperglycemic state
(HHS). Which assessment findings are consistent with this diagnosis? (Select all that apply.)
A. Blood glucose 850 mg/dL [CORRECT]
B. Arterial pH 7.25
C. Serum osmolality 340 mOsm/kg [CORRECT]
D. Altered mental status [CORRECT]
E. Positive serum ketones
F. Kussmaul respirations
Correct Answer: A, C, D
Rationale: HHS is characterized by severe hyperglycemia (typically >600 mg/dL, often 800-1200
mg/dL), hyperosmolality (>320 mOsm/kg, typically 330-380 mOsm/kg), and altered mental
status (confusion to coma) without significant ketosis or acidosis. The pathophysiology involves
profound dehydration and osmotic diuresis without the ketone production seen in DKA. Option
B (pH 7.25) indicates acidosis typical of DKA; HHS patients usually have pH >7.3. Option E
(positive ketones) is characteristic of DKA; HHS shows minimal or absent ketonemia/ketonuria.
Option F (Kussmaul respirations—deep, rapid breathing) is a compensatory mechanism for
metabolic acidosis in DKA, not HHS. [CORRECT: A, C, D]
Q5: A patient with Addison's disease is admitted with acute adrenal crisis. Vital signs: BP 78/52
mmHg, HR 132 bpm, RR 24 breaths/min, temperature 99.8°F (37.7°C). Laboratory results:
sodium 128 mEq/L, potassium 5.9 mEq/L, glucose 54 mg/dL. Which medication should the
nurse prepare to administer first?
A. Oral hydrocortisone 20 mg
B. IV hydrocortisone 100 mg bolus [CORRECT]
C. IV insulin and dextrose to treat hyperkalemia
D. Oral fludrocortisone 0.1 mg
Correct Answer: B
