NUR 425 MedSurg 2 – Exam 3 Actual Exam |
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Part I: Endocrine Emergencies & Chronic Management
Q1: A 24-year-old client with type 1 diabetes arrives in the emergency department with a
blood glucose of 520 mg/dL, pH 7.28, bicarbonate 14 mEq/L, and positive serum
ketones. The client is lethargic but arousable and has Kussmaul respirations. Which
condition best matches this presentation?
A. Hyperosmolar hyperglycemic state (HHS)
B. Hypoglycemic crisis
C. Diabetic ketoacidosis (DKA) [CORRECT]
D. Thyroid storm
Correct Answer: C
Rationale: The best answer is C. This client has the classic triad of DKA: hyperglycemia
over 250, metabolic acidosis with a low bicarb and low pH, and ketosis. The Kussmaul
respirations are the body's attempt to blow off acid, which is a hallmark of this
condition.
Q2: A nurse is caring for a client in DKA who has just been started on an IV insulin
infusion. The client's initial potassium was 5.2 mEq/L. Thirty minutes after insulin
therapy begins, which laboratory value should the nurse monitor most closely?
A. Serum calcium
B. Serum potassium [CORRECT]
C. Serum magnesium
D. Serum phosphate
Correct Answer: B
Rationale: The best answer is B. Insulin drives potassium back into the cells, which can
drop serum potassium dangerously fast. Even though this client started with a slightly
,elevated potassium, insulin therapy can cause a rapid shift to hypokalemia, and that
cardiac risk is what you watch like a hawk in the first few hours.
Q3: A client with type 2 diabetes calls the clinic reporting nausea, vomiting, and diarrhea
for the past 12 hours. The client's blood glucose is 280 mg/dL. Which instruction aligns
best with sick day management rules?
A. Stop taking all diabetes medications until feeling better
B. Hold insulin and only drink water until vomiting subsides
C. Continue taking basal insulin, check glucose every 2–4 hours, and call if unable to
keep fluids down or if glucose stays above 250 [CORRECT]
D. Take extra rapid-acting insulin every hour until glucose normalizes
Correct Answer: C
Rationale: The best answer is C. Sick day rules tell clients to keep taking their basal
insulin because the body still needs it even when not eating well. They need to monitor
more frequently, stay hydrated, and know when to call for help. Stopping insulin or
taking hourly boluses without guidance can lead to DKA or severe hypoglycemia.
Q4: A client with type 1 diabetes is found unconscious at home. The family reports the
client skipped lunch after taking the usual morning insulin dose. The client's skin is cool
and clammy. What is the nurse's priority action?
A. Administer IV dextrose 50% immediately [CORRECT]
B. Start an IV insulin infusion
C. Draw an ABG before treating
D. Administer IV normal saline bolus
Correct Answer: A
Rationale: The best answer is A. Skipped meal plus insulin equals hypoglycemia until
proven otherwise. Cool, clammy skin and altered mental status in a diabetic client
screams low blood sugar. You treat first with IV dextrose and check the glucose
simultaneously; you don't wait for lab confirmation when the clinical picture is this clear.
Q5: A client is admitted with a blood glucose of 880 mg/dL, serum osmolality 330
mOsm/kg, and pH 7.34. The client is confused and has dry mucous membranes. No
ketones are detected in the urine. Which nursing intervention takes priority?
A. Start an insulin drip at 0.1 units/kg/hour immediately
B. Administer rapid-acting subcutaneous insulin only
, C. Begin aggressive IV fluid replacement with 0.9% normal saline to correct dehydration
and lower osmolality gradually [CORRECT]
D. Administer sodium bicarbonate to correct acidosis
Correct Answer: C
Rationale: The best answer is C. This presentation points to HHS, not DKA. The
profound dehydration and hyperosmolality are the life threats here, so fluid replacement
is your first priority. Insulin comes later and must be started slowly once osmolality
begins to drop, because rapid shifts can cause cerebral edema.
Q6: A client newly diagnosed with type 2 diabetes asks the nurse why metformin is
prescribed instead of insulin. Which explanation best describes metformin's mechanism
of action?
A. It stimulates the pancreas to release more insulin
B. It decreases hepatic glucose production and improves peripheral insulin sensitivity
[CORRECT]
C. It blocks carbohydrate absorption in the intestines
D. It replaces insulin the body cannot produce
Correct Answer: B
Rationale: The best answer is B. Metformin is a biguanide that works primarily by
shutting down some of that excess sugar production coming from the liver and by
helping the body's cells respond better to the insulin they already make. It does not
cause hypoglycemia on its own because it doesn't push the pancreas to secrete insulin.
Q7: A client is scheduled for surgery at 0800 and takes NPH insulin at bedtime. The
nurse is reviewing preoperative medication instructions. What is the appropriate
guidance for the evening dose of NPH insulin?
A. Take the usual dose the night before surgery
B. Take 50% of the usual dose the night before surgery [CORRECT]
C. Hold the dose entirely the night before surgery
D. Take double the dose to prepare for fasting
Correct Answer: B
Rationale: The best answer is B. For intermediate-acting insulin like NPH, the standard
approach is usually to reduce the evening dose before surgery because the client will be
NPO and won't have their usual carbohydrate intake. Taking the full dose risks
hypoglycemia during the overnight fast.
Complete Questions and Answers, 100% Verified –
Pass Guaranteed - A+ Graded
Part I: Endocrine Emergencies & Chronic Management
Q1: A 24-year-old client with type 1 diabetes arrives in the emergency department with a
blood glucose of 520 mg/dL, pH 7.28, bicarbonate 14 mEq/L, and positive serum
ketones. The client is lethargic but arousable and has Kussmaul respirations. Which
condition best matches this presentation?
A. Hyperosmolar hyperglycemic state (HHS)
B. Hypoglycemic crisis
C. Diabetic ketoacidosis (DKA) [CORRECT]
D. Thyroid storm
Correct Answer: C
Rationale: The best answer is C. This client has the classic triad of DKA: hyperglycemia
over 250, metabolic acidosis with a low bicarb and low pH, and ketosis. The Kussmaul
respirations are the body's attempt to blow off acid, which is a hallmark of this
condition.
Q2: A nurse is caring for a client in DKA who has just been started on an IV insulin
infusion. The client's initial potassium was 5.2 mEq/L. Thirty minutes after insulin
therapy begins, which laboratory value should the nurse monitor most closely?
A. Serum calcium
B. Serum potassium [CORRECT]
C. Serum magnesium
D. Serum phosphate
Correct Answer: B
Rationale: The best answer is B. Insulin drives potassium back into the cells, which can
drop serum potassium dangerously fast. Even though this client started with a slightly
,elevated potassium, insulin therapy can cause a rapid shift to hypokalemia, and that
cardiac risk is what you watch like a hawk in the first few hours.
Q3: A client with type 2 diabetes calls the clinic reporting nausea, vomiting, and diarrhea
for the past 12 hours. The client's blood glucose is 280 mg/dL. Which instruction aligns
best with sick day management rules?
A. Stop taking all diabetes medications until feeling better
B. Hold insulin and only drink water until vomiting subsides
C. Continue taking basal insulin, check glucose every 2–4 hours, and call if unable to
keep fluids down or if glucose stays above 250 [CORRECT]
D. Take extra rapid-acting insulin every hour until glucose normalizes
Correct Answer: C
Rationale: The best answer is C. Sick day rules tell clients to keep taking their basal
insulin because the body still needs it even when not eating well. They need to monitor
more frequently, stay hydrated, and know when to call for help. Stopping insulin or
taking hourly boluses without guidance can lead to DKA or severe hypoglycemia.
Q4: A client with type 1 diabetes is found unconscious at home. The family reports the
client skipped lunch after taking the usual morning insulin dose. The client's skin is cool
and clammy. What is the nurse's priority action?
A. Administer IV dextrose 50% immediately [CORRECT]
B. Start an IV insulin infusion
C. Draw an ABG before treating
D. Administer IV normal saline bolus
Correct Answer: A
Rationale: The best answer is A. Skipped meal plus insulin equals hypoglycemia until
proven otherwise. Cool, clammy skin and altered mental status in a diabetic client
screams low blood sugar. You treat first with IV dextrose and check the glucose
simultaneously; you don't wait for lab confirmation when the clinical picture is this clear.
Q5: A client is admitted with a blood glucose of 880 mg/dL, serum osmolality 330
mOsm/kg, and pH 7.34. The client is confused and has dry mucous membranes. No
ketones are detected in the urine. Which nursing intervention takes priority?
A. Start an insulin drip at 0.1 units/kg/hour immediately
B. Administer rapid-acting subcutaneous insulin only
, C. Begin aggressive IV fluid replacement with 0.9% normal saline to correct dehydration
and lower osmolality gradually [CORRECT]
D. Administer sodium bicarbonate to correct acidosis
Correct Answer: C
Rationale: The best answer is C. This presentation points to HHS, not DKA. The
profound dehydration and hyperosmolality are the life threats here, so fluid replacement
is your first priority. Insulin comes later and must be started slowly once osmolality
begins to drop, because rapid shifts can cause cerebral edema.
Q6: A client newly diagnosed with type 2 diabetes asks the nurse why metformin is
prescribed instead of insulin. Which explanation best describes metformin's mechanism
of action?
A. It stimulates the pancreas to release more insulin
B. It decreases hepatic glucose production and improves peripheral insulin sensitivity
[CORRECT]
C. It blocks carbohydrate absorption in the intestines
D. It replaces insulin the body cannot produce
Correct Answer: B
Rationale: The best answer is B. Metformin is a biguanide that works primarily by
shutting down some of that excess sugar production coming from the liver and by
helping the body's cells respond better to the insulin they already make. It does not
cause hypoglycemia on its own because it doesn't push the pancreas to secrete insulin.
Q7: A client is scheduled for surgery at 0800 and takes NPH insulin at bedtime. The
nurse is reviewing preoperative medication instructions. What is the appropriate
guidance for the evening dose of NPH insulin?
A. Take the usual dose the night before surgery
B. Take 50% of the usual dose the night before surgery [CORRECT]
C. Hold the dose entirely the night before surgery
D. Take double the dose to prepare for fasting
Correct Answer: B
Rationale: The best answer is B. For intermediate-acting insulin like NPH, the standard
approach is usually to reduce the evening dose before surgery because the client will be
NPO and won't have their usual carbohydrate intake. Taking the full dose risks
hypoglycemia during the overnight fast.
