NUR 425 MedSurg 2 – Exam 3 Actual Exam | Latest
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Part I: Endocrine Emergencies & Chronic Management
Q1: A 45-year-old patient with Type 1 diabetes presents to the ED with Kussmaul
respirations, fruity breath odor, and a blood glucose of 350 mg/dL. The arterial blood
gas (ABG) results show pH 7.25, PaCO2 30, and HCO3- 18. Which intervention is the
priority based on this assessment?
A. Administer 5% dextrose intravenously.
B. Initiate insulin infusion and fluid resuscitation. [CORRECT]
C. Administer sodium bicarbonate immediately.
D. Encourage oral intake of water and carbohydrates.
Correct Answer: B
Rationale: The best answer is B because the patient is showing signs of Diabetic
Ketoacidosis (DKA) caused by severe insulin deficiency; the priority management
involves replacing fluids to correct dehydration and administering insulin to stop
ketogenesis and correct acidosis.
Q2: You are caring for an 80-year-old patient diagnosed with Hyperosmolar
Hyperglycemic State (HHS). Unlike DKA, which clinical manifestation is typically absent
or minimal in HHS?
A. Severe dehydration
B. Altered mental status
C. Kussmaul respirations and ketoacidosis [CORRECT]
D. Marked hyperglycemia
Correct Answer: C
Rationale: This choice is correct because HHS is characterized by extreme
hyperglycemia and dehydration without significant ketone production; therefore, patients
typically do not present with Kussmaul respirations or the profound metabolic acidosis
seen in DKA.
Q3: A patient with diabetes reports feeling shaky, sweaty, and dizzy during their hospital
stay. Their point-of-care glucose is 58 mg/dL. They are currently able to swallow safely.
Which action should you take first?
A. Administer 1 mg of glucagon intramuscularly.
, B. Give 15 grams of rapid-acting carbohydrate, such as 4 oz of juice. [CORRECT]
C. Start an IV infusion of D50W.
D. Check the hemoglobin A1C level.
Correct Answer: B
Rationale: This aligns with the "15-15 Rule" for hypoglycemia where a conscious patient
who can swallow should first receive 15 grams of rapid-acting carbohydrate to raise
blood sugar quickly.
Q4: When teaching a patient about "Sick Day Rules" for Type 2 diabetes management,
which instruction is most critical to prevent complications like DKA or HHS?
A. Stop taking oral antihyperglycemics until fever resolves.
B. Test urine for ketones and blood glucose every 4 hours. [CORRECT]
C. Reduce fluid intake to prevent overhydration.
D. Increase carbohydrate intake to boost energy.
Correct Answer: B
Rationale: The best answer is B because monitoring blood glucose and urine ketones
frequently during illness allows for early detection of metabolic decompensation,
enabling timely intervention with insulin and fluids to prevent emergency status.
Q5: A nurse is preparing to administer regular insulin via IV push for a patient with DKA.
Which lab value must be closely monitored immediately before and during insulin
therapy to prevent a life-threatening complication?
A. Serum sodium
B. Serum potassium [CORRECT]
C. Serum creatinine
D. Serum magnesium
Correct Answer: B
Rationale: This matches the pathophysiology where insulin drives potassium into cells;
if the patient is hypokalemic prior to administration, insulin can cause severe
arrhythmias or cardiac arrest, so potassium must be corrected first.
Q6: You are teaching a patient newly diagnosed with Type 2 diabetes about
glycosylated hemoglobin (HbA1c). What does this test primarily reflect?
A. The patient's fasting blood glucose for the past 24 hours.
B. The average blood glucose level over the past 2 to 3 months. [CORRECT]
C. The presence of ketones in the urine.
D. The kidney’s ability to filter glucose.
Correct Answer: B
Rationale: This choice is correct because the HbA1c test measures the percentage of
glycated hemoglobin, providing an average of blood glucose levels over the lifespan of
the red blood cell, approximately 120 days.
Update | Correct & Verified with Detailed Rationales
Pass Guaranteed - A+ Graded
Part I: Endocrine Emergencies & Chronic Management
Q1: A 45-year-old patient with Type 1 diabetes presents to the ED with Kussmaul
respirations, fruity breath odor, and a blood glucose of 350 mg/dL. The arterial blood
gas (ABG) results show pH 7.25, PaCO2 30, and HCO3- 18. Which intervention is the
priority based on this assessment?
A. Administer 5% dextrose intravenously.
B. Initiate insulin infusion and fluid resuscitation. [CORRECT]
C. Administer sodium bicarbonate immediately.
D. Encourage oral intake of water and carbohydrates.
Correct Answer: B
Rationale: The best answer is B because the patient is showing signs of Diabetic
Ketoacidosis (DKA) caused by severe insulin deficiency; the priority management
involves replacing fluids to correct dehydration and administering insulin to stop
ketogenesis and correct acidosis.
Q2: You are caring for an 80-year-old patient diagnosed with Hyperosmolar
Hyperglycemic State (HHS). Unlike DKA, which clinical manifestation is typically absent
or minimal in HHS?
A. Severe dehydration
B. Altered mental status
C. Kussmaul respirations and ketoacidosis [CORRECT]
D. Marked hyperglycemia
Correct Answer: C
Rationale: This choice is correct because HHS is characterized by extreme
hyperglycemia and dehydration without significant ketone production; therefore, patients
typically do not present with Kussmaul respirations or the profound metabolic acidosis
seen in DKA.
Q3: A patient with diabetes reports feeling shaky, sweaty, and dizzy during their hospital
stay. Their point-of-care glucose is 58 mg/dL. They are currently able to swallow safely.
Which action should you take first?
A. Administer 1 mg of glucagon intramuscularly.
, B. Give 15 grams of rapid-acting carbohydrate, such as 4 oz of juice. [CORRECT]
C. Start an IV infusion of D50W.
D. Check the hemoglobin A1C level.
Correct Answer: B
Rationale: This aligns with the "15-15 Rule" for hypoglycemia where a conscious patient
who can swallow should first receive 15 grams of rapid-acting carbohydrate to raise
blood sugar quickly.
Q4: When teaching a patient about "Sick Day Rules" for Type 2 diabetes management,
which instruction is most critical to prevent complications like DKA or HHS?
A. Stop taking oral antihyperglycemics until fever resolves.
B. Test urine for ketones and blood glucose every 4 hours. [CORRECT]
C. Reduce fluid intake to prevent overhydration.
D. Increase carbohydrate intake to boost energy.
Correct Answer: B
Rationale: The best answer is B because monitoring blood glucose and urine ketones
frequently during illness allows for early detection of metabolic decompensation,
enabling timely intervention with insulin and fluids to prevent emergency status.
Q5: A nurse is preparing to administer regular insulin via IV push for a patient with DKA.
Which lab value must be closely monitored immediately before and during insulin
therapy to prevent a life-threatening complication?
A. Serum sodium
B. Serum potassium [CORRECT]
C. Serum creatinine
D. Serum magnesium
Correct Answer: B
Rationale: This matches the pathophysiology where insulin drives potassium into cells;
if the patient is hypokalemic prior to administration, insulin can cause severe
arrhythmias or cardiac arrest, so potassium must be corrected first.
Q6: You are teaching a patient newly diagnosed with Type 2 diabetes about
glycosylated hemoglobin (HbA1c). What does this test primarily reflect?
A. The patient's fasting blood glucose for the past 24 hours.
B. The average blood glucose level over the past 2 to 3 months. [CORRECT]
C. The presence of ketones in the urine.
D. The kidney’s ability to filter glucose.
Correct Answer: B
Rationale: This choice is correct because the HbA1c test measures the percentage of
glycated hemoglobin, providing an average of blood glucose levels over the lifespan of
the red blood cell, approximately 120 days.
