Grand Canyon University NSG-320 Exam 3 2026/2027
| Actual Questions
Grand Canyon University College of Nursing | Actual Q&A |
Undergraduate Nursing Students
Introduction
This comprehensive examination preparation resource contains 150 original questions specifically
designed for the Grand Canyon University NSG-320 Adult Health I course, Exam 3. The questions
cover four major content domains: Endocrine System Disorders and Management (38 questions),
Neurological System Disorders and Management (37 questions), Musculoskeletal System Disorders
and Management (38 questions), and Sensory (Eye and Ear) Disorders and Management (37
questions). These questions are carefully crafted to reinforce GCU NSG-320 course objectives and
prepare undergraduate nursing students for exam readiness. Each question includes a detailed
rationale based on medical-surgical nursing principles, pathophysiology, pharmacology, nursing
assessments, patient education, and clinical decision-making. The content aligns with the Medical-
Surgical Nursing: Concepts for Interprofessional Collaborative Care textbook by Elkin and standard
GCU NSG-320 course materials.
Content Area Overview
Content Area Questions Key Topics Weight
Endocrine System 38 Diabetes mellitus (Type 1 & 2), DKA, HHS, 25%
Disorders and thyroid disorders, adrenal insufficiency,
Management Cushing's syndrome, Addison's disease,
pheochromocytoma, diabetes insipidus, SIADH
Neurological System 37 Stroke (ischemic & hemorrhagic), traumatic 25%
Disorders and brain injury, seizures & epilepsy, multiple
Management sclerosis, increased ICP, meningitis,
Parkinson's disease
Musculoskeletal System 38 Fractures, osteoarthritis, rheumatoid arthritis, 25%
Disorders and osteoporosis, joint replacement, back pain,
Management musculoskeletal trauma, compartment
syndrome
Sensory (Eye and Ear) 37 Glaucoma, cataracts, macular degeneration, 25%
Disorders and hearing loss, Meniere's disease, eye trauma,
Management otitis media & externa
TOTAL 150 100%
Grand Canyon University NSG-320 Exam 3 2026/2027
,Domain: Endocrine System Disorders and Management
Question 1:A 16-year-old patient with type 1 diabetes mellitus is admitted with nausea,
vomiting, and fruity breath odor. Which metabolic process is primarily responsible for
these clinical manifestations?
A. Excessive glucose uptake by peripheral tissues
B. Breakdown of fatty acids producing ketone bodies
C. Increased glycogen synthesis in the liver
D. Enhanced insulin secretion from pancreatic beta cells
Answer: B
Rationale: In type 1 diabetes mellitus, absolute insulin deficiency leads to the breakdown of fatty
acids for energy, producing ketone bodies. This process, called ketogenesis, results in diabetic
ketoacidosis (DKA), characterized by nausea, vomiting, and fruity (acetone) breath odor.
Question 2:Which laboratory finding is most characteristic of a patient presenting with
diabetic ketoacidosis (DKA)?
A. Blood glucose of 180 mg/dL and pH of 7.38
B. Blood glucose of 450 mg/dL, pH of 7.25, and positive serum ketones
C. Blood glucose of 800 mg/dL and pH of 7.35 without ketones
D. Blood glucose of 120 mg/dL and pH of 7.42
Answer: B
Rationale: DKA is characterized by hyperglycemia (typically >250 mg/dL), metabolic acidosis (pH
<7.30), and positive serum ketones. The combination of elevated blood glucose, low pH, and
ketonemia distinguishes DKA from other hyperglycemic states.
Question 3:A patient with type 1 diabetes is scheduled for an abdominal CT scan with
contrast dye at 10:00 AM. The patient normally takes 20 units of long-acting insulin
glargine at bedtime. What is the nurse's priority action regarding insulin
administration?
A. Hold all insulin doses on the morning of the procedure
B. Administer the usual glargine dose the evening before the procedure
C. Switch to regular insulin for the day of the procedure
D. Administer half the usual glargine dose on the morning of the procedure
Answer: B
Rationale: Long-acting insulin glargine provides basal insulin coverage and should be administered
as prescribed. Holding basal insulin can lead to hyperglycemia and ketosis. The patient may need to
hold metformin due to contrast dye, but insulin glargine should continue.
Question 4:The nurse is teaching a patient with newly diagnosed type 1 diabetes about
hypoglycemia. Which statement by the patient indicates an understanding of the 'rule
of 15' for treating hypoglycemia?
A. "I should eat 15 grams of carbohydrate and recheck my glucose in 2 hours."
B. "I should consume 15 grams of carbohydrate and recheck my glucose in 15 minutes."
C. "I should inject 15 units of glucagon and call 911 immediately."
D. "I should drink 15 ounces of water and rest for 15 minutes."
Answer: B
Rationale: The 'rule of 15' for treating hypoglycemia involves consuming 15 grams of fast-acting
carbohydrate (glucose tablets, juice, or regular soda) and rechecking blood glucose in 15 minutes.
This process is repeated until blood glucose returns to normal (>70 mg/dL).
Grand Canyon University NSG-320 Exam 3 2026/2027
,Question 5:Which nursing intervention is the highest priority when caring for a patient
in the acute phase of diabetic ketoacidosis?
A. Administer sliding-scale regular insulin
B. Establish intravenous access and begin fluid resuscitation with normal saline
C. Obtain a 12-lead electrocardiogram
D. Insert a nasogastric tube for gastric decompression
Answer: B
Rationale: Fluid resuscitation with isotonic normal saline is the first priority in DKA management.
Patients with DKA are typically volume-depleted by 3-6 liters due to osmotic diuresis. Restoring
intravascular volume improves tissue perfusion and renal function before insulin therapy begins.
Question 6:A patient with type 1 diabetes develops dawn phenomenon. Which clinical
finding best describes this condition?
A. Hypoglycemia at 3:00 AM followed by rebound hyperglycemia at 7:00 AM
B. Early morning hyperglycemia due to counter-regulatory hormone secretion between 4:00 AM
and 8:00 AM
C. Postprandial hyperglycemia persisting for more than 4 hours after meals
D. Recurrent hypoglycemia throughout the night without warning symptoms
Answer: B
Rationale: Dawn phenomenon is early morning hyperglycemia (typically 4:00-8:00 AM) caused by
normal nocturnal secretion of counter-regulatory hormones including growth hormone, cortisol,
and catecholamines. These hormones increase hepatic glucose production and insulin resistance.
Question 7:The nurse is caring for a patient with type 1 diabetes who is receiving
continuous insulin infusion. Which assessment finding requires immediate nursing
intervention?
A. Blood glucose decreasing from 400 mg/dL to 250 mg/dL over 4 hours
B. Potassium level of 3.2 mEq/L during insulin infusion
C. Urine output of 50 mL/hour
D. Serum bicarbonate level of 18 mEq/L
Answer: B
Rationale: Insulin drives potassium intracellularly, which can cause severe hypokalemia. A
potassium level of 3.2 mEq/L is dangerously low and requires immediate potassium
supplementation. Insulin therapy should not be initiated if potassium is <3.3 mEq/L, as this
increases the risk of cardiac dysrhythmias.
Question 8:Which clinical manifestation distinguishes Somogyi effect from dawn
phenomenon in a patient with type 1 diabetes?
A. Both conditions cause morning hypoglycemia
B. Somogyi effect causes morning hyperglycemia preceded by nocturnal hypoglycemia
C. Dawn phenomenon is caused by excessive insulin administration at bedtime
D. Somogyi effect is treated by increasing bedtime insulin dose
Answer: B
Rationale: Somogyi effect is rebound hyperglycemia in the morning caused by counter-regulatory
hormone response to nocturnal hypoglycemia (typically 2:00-3:00 AM). Dawn phenomenon is
morning hyperglycemia without preceding hypoglycemia, caused by normal early morning
hormone secretion. Checking 3:00 AM glucose distinguishes these conditions.
Question 9:A patient with type 2 diabetes mellitus is prescribed metformin. Which
mechanism of action best describes how this medication lowers blood glucose?
A. Stimulates insulin secretion from pancreatic beta cells
Grand Canyon University NSG-320 Exam 3 2026/2027
, B. Decreases hepatic glucose production and improves peripheral insulin sensitivity
C. Delays carbohydrate absorption in the intestines
D. Increases renal excretion of glucose
Answer: B
Rationale: Metformin is a biguanide that primarily works by decreasing hepatic gluconeogenesis
and glycogenolysis. It also improves peripheral insulin sensitivity in muscle and adipose tissue.
Metformin does not stimulate insulin secretion and rarely causes hypoglycemia when used alone.
Question 10:The nurse is teaching a patient about foot care related to diabetes mellitus.
Which instruction is most important to prevent diabetic foot complications?
A. Soak feet in warm water for 30 minutes daily to improve circulation
B. Inspect feet daily including between the toes and use moisturizer on all foot surfaces
C. Walk barefoot at home to strengthen foot muscles
D. Trim toenails in a curved shape to prevent ingrown nails
Answer: B
Rationale: Daily foot inspection including between toes is essential for early detection of blisters,
cuts, or infections. Moisturizer should be applied to dry skin but not between toes to prevent
maceration. Patients should avoid soaking feet, walking barefoot, and should trim toenails straight
across.
Question 11:A patient with type 2 diabetes is prescribed insulin glargine at bedtime and
insulin lispro before meals. What is the primary purpose of the glargine insulin in this
regimen?
A. To cover postprandial blood glucose spikes
B. To provide basal insulin coverage between meals and overnight
C. To treat acute hyperglycemic emergencies
D. To suppress glucagon secretion during meals
Answer: B
Rationale: Insulin glargine is a long-acting basal insulin that provides steady background insulin
coverage for approximately 24 hours. It mimics the pancreas's basal insulin secretion between
meals and overnight. Rapid-acting insulin lispro covers mealtime (bolus) glucose excursions.
Question 12:Which assessment finding in a patient with diabetes mellitus is most
indicative of autonomic neuropathy?
A. Numbness and tingling in a stocking-glove distribution
B. Resting tachycardia and orthostatic hypotension
C. Sharp, burning pain in the lower extremities
D. Decreased deep tendon reflexes in the ankles
Answer: B
Rationale: Autonomic neuropathy affects the involuntary nervous system. Cardiovascular
manifestations include resting tachycardia (due to vagal denervation) and orthostatic hypotension
(impaired vasoconstriction). Stocking-glove paresthesia and decreased reflexes indicate somatic
peripheral neuropathy.
Question 13:A patient with type 2 diabetes has a glycosylated hemoglobin (HbA1c) of
9.5%. What does this value indicate about the patient's blood glucose control?
A. Excellent control with an estimated average glucose of 120 mg/dL
B. Good control with blood glucose consistently below 140 mg/dL
C. Poor control with an estimated average glucose of approximately 226 mg/dL
D. Prediabetic range indicating impaired glucose tolerance
Answer: C
Grand Canyon University NSG-320 Exam 3 2026/2027
| Actual Questions
Grand Canyon University College of Nursing | Actual Q&A |
Undergraduate Nursing Students
Introduction
This comprehensive examination preparation resource contains 150 original questions specifically
designed for the Grand Canyon University NSG-320 Adult Health I course, Exam 3. The questions
cover four major content domains: Endocrine System Disorders and Management (38 questions),
Neurological System Disorders and Management (37 questions), Musculoskeletal System Disorders
and Management (38 questions), and Sensory (Eye and Ear) Disorders and Management (37
questions). These questions are carefully crafted to reinforce GCU NSG-320 course objectives and
prepare undergraduate nursing students for exam readiness. Each question includes a detailed
rationale based on medical-surgical nursing principles, pathophysiology, pharmacology, nursing
assessments, patient education, and clinical decision-making. The content aligns with the Medical-
Surgical Nursing: Concepts for Interprofessional Collaborative Care textbook by Elkin and standard
GCU NSG-320 course materials.
Content Area Overview
Content Area Questions Key Topics Weight
Endocrine System 38 Diabetes mellitus (Type 1 & 2), DKA, HHS, 25%
Disorders and thyroid disorders, adrenal insufficiency,
Management Cushing's syndrome, Addison's disease,
pheochromocytoma, diabetes insipidus, SIADH
Neurological System 37 Stroke (ischemic & hemorrhagic), traumatic 25%
Disorders and brain injury, seizures & epilepsy, multiple
Management sclerosis, increased ICP, meningitis,
Parkinson's disease
Musculoskeletal System 38 Fractures, osteoarthritis, rheumatoid arthritis, 25%
Disorders and osteoporosis, joint replacement, back pain,
Management musculoskeletal trauma, compartment
syndrome
Sensory (Eye and Ear) 37 Glaucoma, cataracts, macular degeneration, 25%
Disorders and hearing loss, Meniere's disease, eye trauma,
Management otitis media & externa
TOTAL 150 100%
Grand Canyon University NSG-320 Exam 3 2026/2027
,Domain: Endocrine System Disorders and Management
Question 1:A 16-year-old patient with type 1 diabetes mellitus is admitted with nausea,
vomiting, and fruity breath odor. Which metabolic process is primarily responsible for
these clinical manifestations?
A. Excessive glucose uptake by peripheral tissues
B. Breakdown of fatty acids producing ketone bodies
C. Increased glycogen synthesis in the liver
D. Enhanced insulin secretion from pancreatic beta cells
Answer: B
Rationale: In type 1 diabetes mellitus, absolute insulin deficiency leads to the breakdown of fatty
acids for energy, producing ketone bodies. This process, called ketogenesis, results in diabetic
ketoacidosis (DKA), characterized by nausea, vomiting, and fruity (acetone) breath odor.
Question 2:Which laboratory finding is most characteristic of a patient presenting with
diabetic ketoacidosis (DKA)?
A. Blood glucose of 180 mg/dL and pH of 7.38
B. Blood glucose of 450 mg/dL, pH of 7.25, and positive serum ketones
C. Blood glucose of 800 mg/dL and pH of 7.35 without ketones
D. Blood glucose of 120 mg/dL and pH of 7.42
Answer: B
Rationale: DKA is characterized by hyperglycemia (typically >250 mg/dL), metabolic acidosis (pH
<7.30), and positive serum ketones. The combination of elevated blood glucose, low pH, and
ketonemia distinguishes DKA from other hyperglycemic states.
Question 3:A patient with type 1 diabetes is scheduled for an abdominal CT scan with
contrast dye at 10:00 AM. The patient normally takes 20 units of long-acting insulin
glargine at bedtime. What is the nurse's priority action regarding insulin
administration?
A. Hold all insulin doses on the morning of the procedure
B. Administer the usual glargine dose the evening before the procedure
C. Switch to regular insulin for the day of the procedure
D. Administer half the usual glargine dose on the morning of the procedure
Answer: B
Rationale: Long-acting insulin glargine provides basal insulin coverage and should be administered
as prescribed. Holding basal insulin can lead to hyperglycemia and ketosis. The patient may need to
hold metformin due to contrast dye, but insulin glargine should continue.
Question 4:The nurse is teaching a patient with newly diagnosed type 1 diabetes about
hypoglycemia. Which statement by the patient indicates an understanding of the 'rule
of 15' for treating hypoglycemia?
A. "I should eat 15 grams of carbohydrate and recheck my glucose in 2 hours."
B. "I should consume 15 grams of carbohydrate and recheck my glucose in 15 minutes."
C. "I should inject 15 units of glucagon and call 911 immediately."
D. "I should drink 15 ounces of water and rest for 15 minutes."
Answer: B
Rationale: The 'rule of 15' for treating hypoglycemia involves consuming 15 grams of fast-acting
carbohydrate (glucose tablets, juice, or regular soda) and rechecking blood glucose in 15 minutes.
This process is repeated until blood glucose returns to normal (>70 mg/dL).
Grand Canyon University NSG-320 Exam 3 2026/2027
,Question 5:Which nursing intervention is the highest priority when caring for a patient
in the acute phase of diabetic ketoacidosis?
A. Administer sliding-scale regular insulin
B. Establish intravenous access and begin fluid resuscitation with normal saline
C. Obtain a 12-lead electrocardiogram
D. Insert a nasogastric tube for gastric decompression
Answer: B
Rationale: Fluid resuscitation with isotonic normal saline is the first priority in DKA management.
Patients with DKA are typically volume-depleted by 3-6 liters due to osmotic diuresis. Restoring
intravascular volume improves tissue perfusion and renal function before insulin therapy begins.
Question 6:A patient with type 1 diabetes develops dawn phenomenon. Which clinical
finding best describes this condition?
A. Hypoglycemia at 3:00 AM followed by rebound hyperglycemia at 7:00 AM
B. Early morning hyperglycemia due to counter-regulatory hormone secretion between 4:00 AM
and 8:00 AM
C. Postprandial hyperglycemia persisting for more than 4 hours after meals
D. Recurrent hypoglycemia throughout the night without warning symptoms
Answer: B
Rationale: Dawn phenomenon is early morning hyperglycemia (typically 4:00-8:00 AM) caused by
normal nocturnal secretion of counter-regulatory hormones including growth hormone, cortisol,
and catecholamines. These hormones increase hepatic glucose production and insulin resistance.
Question 7:The nurse is caring for a patient with type 1 diabetes who is receiving
continuous insulin infusion. Which assessment finding requires immediate nursing
intervention?
A. Blood glucose decreasing from 400 mg/dL to 250 mg/dL over 4 hours
B. Potassium level of 3.2 mEq/L during insulin infusion
C. Urine output of 50 mL/hour
D. Serum bicarbonate level of 18 mEq/L
Answer: B
Rationale: Insulin drives potassium intracellularly, which can cause severe hypokalemia. A
potassium level of 3.2 mEq/L is dangerously low and requires immediate potassium
supplementation. Insulin therapy should not be initiated if potassium is <3.3 mEq/L, as this
increases the risk of cardiac dysrhythmias.
Question 8:Which clinical manifestation distinguishes Somogyi effect from dawn
phenomenon in a patient with type 1 diabetes?
A. Both conditions cause morning hypoglycemia
B. Somogyi effect causes morning hyperglycemia preceded by nocturnal hypoglycemia
C. Dawn phenomenon is caused by excessive insulin administration at bedtime
D. Somogyi effect is treated by increasing bedtime insulin dose
Answer: B
Rationale: Somogyi effect is rebound hyperglycemia in the morning caused by counter-regulatory
hormone response to nocturnal hypoglycemia (typically 2:00-3:00 AM). Dawn phenomenon is
morning hyperglycemia without preceding hypoglycemia, caused by normal early morning
hormone secretion. Checking 3:00 AM glucose distinguishes these conditions.
Question 9:A patient with type 2 diabetes mellitus is prescribed metformin. Which
mechanism of action best describes how this medication lowers blood glucose?
A. Stimulates insulin secretion from pancreatic beta cells
Grand Canyon University NSG-320 Exam 3 2026/2027
, B. Decreases hepatic glucose production and improves peripheral insulin sensitivity
C. Delays carbohydrate absorption in the intestines
D. Increases renal excretion of glucose
Answer: B
Rationale: Metformin is a biguanide that primarily works by decreasing hepatic gluconeogenesis
and glycogenolysis. It also improves peripheral insulin sensitivity in muscle and adipose tissue.
Metformin does not stimulate insulin secretion and rarely causes hypoglycemia when used alone.
Question 10:The nurse is teaching a patient about foot care related to diabetes mellitus.
Which instruction is most important to prevent diabetic foot complications?
A. Soak feet in warm water for 30 minutes daily to improve circulation
B. Inspect feet daily including between the toes and use moisturizer on all foot surfaces
C. Walk barefoot at home to strengthen foot muscles
D. Trim toenails in a curved shape to prevent ingrown nails
Answer: B
Rationale: Daily foot inspection including between toes is essential for early detection of blisters,
cuts, or infections. Moisturizer should be applied to dry skin but not between toes to prevent
maceration. Patients should avoid soaking feet, walking barefoot, and should trim toenails straight
across.
Question 11:A patient with type 2 diabetes is prescribed insulin glargine at bedtime and
insulin lispro before meals. What is the primary purpose of the glargine insulin in this
regimen?
A. To cover postprandial blood glucose spikes
B. To provide basal insulin coverage between meals and overnight
C. To treat acute hyperglycemic emergencies
D. To suppress glucagon secretion during meals
Answer: B
Rationale: Insulin glargine is a long-acting basal insulin that provides steady background insulin
coverage for approximately 24 hours. It mimics the pancreas's basal insulin secretion between
meals and overnight. Rapid-acting insulin lispro covers mealtime (bolus) glucose excursions.
Question 12:Which assessment finding in a patient with diabetes mellitus is most
indicative of autonomic neuropathy?
A. Numbness and tingling in a stocking-glove distribution
B. Resting tachycardia and orthostatic hypotension
C. Sharp, burning pain in the lower extremities
D. Decreased deep tendon reflexes in the ankles
Answer: B
Rationale: Autonomic neuropathy affects the involuntary nervous system. Cardiovascular
manifestations include resting tachycardia (due to vagal denervation) and orthostatic hypotension
(impaired vasoconstriction). Stocking-glove paresthesia and decreased reflexes indicate somatic
peripheral neuropathy.
Question 13:A patient with type 2 diabetes has a glycosylated hemoglobin (HbA1c) of
9.5%. What does this value indicate about the patient's blood glucose control?
A. Excellent control with an estimated average glucose of 120 mg/dL
B. Good control with blood glucose consistently below 140 mg/dL
C. Poor control with an estimated average glucose of approximately 226 mg/dL
D. Prediabetic range indicating impaired glucose tolerance
Answer: C
Grand Canyon University NSG-320 Exam 3 2026/2027
