NUR 170 Exam 3 Med Surg | 165 Study Questions
and Answers + Expert Rationales | 2026 Updated |
100% correct
1. A client recently admitted with new-onset type 2 diabetes will be discharged with a meter for
self-monitoring of blood glucose (SMBG) levels. When is the best time for the nurse to explain
to the client the proper use of the glucose monitor?
A. During the admission process
B. While performing the test in the hospital
C. On the day of discharge
D. After the client has received written instructions
Correct Answer: B
Expert Rationale: The most effective teaching occurs during the actual performance of the skill
—"teachable moments" when the client can see the equipment, ask questions, and practice
with the nurse's guidance. This experiential learning approach is superior to verbal instruction
alone. The 2026 NICE guidelines for type 2 diabetes emphasize that structured education should
be offered from diagnosis, with practical, hands-on demonstration being the gold standard for
diabetes self-management. Teaching during admission (A) is too early; the client may be
overwhelmed. Discharge day (C) leaves insufficient time for practice and reinforcement.
2. An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. When
the cardiac monitor shows ventricular ectopy, which assessment will the nurse make?
A. Sodium level
B. Potassium level
C. Calcium level
D. Magnesium level
Correct Answer: B
Expert Rationale: Hypokalemia is a critical concern in DKA treatment. Insulin drives potassium
into cells, and clients with DKA often have total body potassium depletion from osmotic
diuresis. Ventricular ectopy (premature ventricular contractions) is a classic sign of hypokalemia.
The nurse must assess potassium levels immediately, as hypokalemia can lead to life-
threatening arrhythmias. Sodium (A), calcium (C), and magnesium (D) are not directly
implicated in this scenario.
,3. A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic
clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin
(HbA1C) is 8.2%. Which action will the nurse take next?
A. Increase the metformin dosage
B. Ask the client about current dietary intake and medication use
C. Order a repeat HbA1C test
D. Refer the client to a dietitian
Correct Answer: B
Expert Rationale: The HbA1C of 8.2% indicates hyperglycemia despite a normal fasting blood
glucose. This discrepancy suggests poor glucose control throughout the day, likely related to
dietary intake or medication adherence. The nurse should first conduct a thorough assessment
of the client's current diet and medication use. The 2026 Polish Federation for Education in
Diabetology (PFED) guidelines emphasize that individualized assessment of lifestyle factors is
essential before making medication changes . The 2026 NICE guidelines also emphasize
collaborative, person-centered target-setting rather than automatically increasing medications .
Increasing the metformin dosage (A) would be premature without assessing non-adherence or
dietary patterns. The 2026 PFED guidelines also highlight that nursing care must integrate
physical, social, and psychological assessments for holistic diabetes management .
4. The nurse is providing discharge teaching to a client with type 2 diabetes and peripheral
neuropathy. Which statement by the client indicates a need for further teaching about injury
prevention?
A. "I should check my shoes for foreign objects before putting them on."
B. "I can break in my shoes by wearing them all day."
C. "I should wear white socks to spot any drainage."
D. "I should inspect my feet daily."
Correct Answer: B
Expert Rationale: Clients with peripheral neuropathy have decreased sensation in their feet and
cannot feel pressure or friction from tight shoes. Wearing new shoes all day to "break them in"
risks developing pressure ulcers or blisters that can become infected and lead to amputation.
The PFED 2026 nursing guidelines recommend that patients with neuropathy should be taught
to inspect their feet daily, wear properly fitting shoes, and avoid soaking feet or walking
barefoot . Options A, C, and D indicate correct understanding of foot care principles.
,5. A client with type 1 diabetes arrives in the emergency department breathing deeply and
stating, "I can't catch my breath." The client's vital signs are: T 98.4°F (36.9°C), P 112 beats/min,
R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action will the
nurse take first?
A. Administer oxygen
B. Check the blood glucose
C. Obtain a chest x-ray
D. Start an IV line
Correct Answer: B
Expert Rationale: The client is exhibiting Kussmaul respirations (deep, rapid breathing) typical of
diabetic ketoacidosis (DKA)—the body's compensatory mechanism for metabolic acidosis. The
vital signs show tachycardia and hypotension, consistent with DKA. The priority is to check the
blood glucose to confirm hyperglycemia and guide immediate treatment. Oxygen (A) is not
indicated with SpO2 99%. Chest x-ray (C) and IV access (D) are important but secondary to
confirming the diagnosis.
6. The clinic nurse is providing teaching to a client with newly diagnosed diabetes. Which
statement by the client indicates a correct understanding about the need to wear a MedicAlert
bracelet?
A. "It will help the hospital staff identify my family."
B. "If I become hypoglycemic, I could become unconscious."
C. "It ensures I receive the correct meal tray."
D. "It is required by the American Diabetes Association."
Correct Answer: B
Expert Rationale: A MedicAlert bracelet provides critical information if the client becomes
unconscious due to severe hypoglycemia, hyperglycemia, or diabetic emergencies. It alerts
healthcare providers to the diagnosis of diabetes, allowing for rapid administration of glucose or
other treatments. The PFED 2026 guidelines recommend that all clients with diabetes,
particularly those on insulin, should wear medical identification .
, 7. The nurse in the endocrine clinic is reviewing type 1 and type 2 diabetes with a group of
nursing students. Which explanation by the students indicates their understanding of the types
of diabetes?
A. "Those with type 1 diabetes make insulin but in inadequate amounts."
B. "Those with type 2 diabetes make insulin, but in inadequate amounts."
C. "Type 1 diabetes can be prevented with proper diet."
D. "Type 2 diabetes only occurs in older adults."
Correct Answer: B
Expert Rationale: Type 2 diabetes involves insulin resistance with relative insulin deficiency—the
pancreas produces insulin but not enough to overcome cellular resistance. In type 1 diabetes,
the pancreas produces little to no insulin due to autoimmune destruction of beta cells. The
2026 NICE guidelines distinguish between these mechanisms for appropriate treatment
selection, with type 2 management involving lifestyle modifications and medications to enhance
insulin sensitivity . Type 1 diabetes is not preventable (C), and type 2 can occur at any age,
including in younger adults (D).
8. Which nursing action will the home health nurse delegate to a home health aide who is
making daily visits to a client with newly diagnosed type 2 diabetes?
A. Assist the client with washing the feet and applying moisturizing lotion
B. Check the client's blood glucose level
C. Administer the client's insulin injection
D. Teach the client about dietary modifications
Correct Answer: A
Expert Rationale: Assisting with foot care (washing and applying lotion) is within the scope of
practice for a home health aide and can be safely delegated. Checking blood glucose (B)
requires a licensed nurse's assessment and interpretation. Insulin administration (C) and client
teaching (D) require licensed nursing judgment. The PFED 2026 nursing guidelines emphasize
that foot care is essential but can be delegated to assistive personnel under the nurse's
supervision .
9. The nurse has just taken change-of-shift report on a group of clients on the medical-surgical
unit. Which client does the nurse assess first?
and Answers + Expert Rationales | 2026 Updated |
100% correct
1. A client recently admitted with new-onset type 2 diabetes will be discharged with a meter for
self-monitoring of blood glucose (SMBG) levels. When is the best time for the nurse to explain
to the client the proper use of the glucose monitor?
A. During the admission process
B. While performing the test in the hospital
C. On the day of discharge
D. After the client has received written instructions
Correct Answer: B
Expert Rationale: The most effective teaching occurs during the actual performance of the skill
—"teachable moments" when the client can see the equipment, ask questions, and practice
with the nurse's guidance. This experiential learning approach is superior to verbal instruction
alone. The 2026 NICE guidelines for type 2 diabetes emphasize that structured education should
be offered from diagnosis, with practical, hands-on demonstration being the gold standard for
diabetes self-management. Teaching during admission (A) is too early; the client may be
overwhelmed. Discharge day (C) leaves insufficient time for practice and reinforcement.
2. An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. When
the cardiac monitor shows ventricular ectopy, which assessment will the nurse make?
A. Sodium level
B. Potassium level
C. Calcium level
D. Magnesium level
Correct Answer: B
Expert Rationale: Hypokalemia is a critical concern in DKA treatment. Insulin drives potassium
into cells, and clients with DKA often have total body potassium depletion from osmotic
diuresis. Ventricular ectopy (premature ventricular contractions) is a classic sign of hypokalemia.
The nurse must assess potassium levels immediately, as hypokalemia can lead to life-
threatening arrhythmias. Sodium (A), calcium (C), and magnesium (D) are not directly
implicated in this scenario.
,3. A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic
clinic. The fasting blood glucose is 108 mg/dL (6.0 mmol/L), and the glycosylated hemoglobin
(HbA1C) is 8.2%. Which action will the nurse take next?
A. Increase the metformin dosage
B. Ask the client about current dietary intake and medication use
C. Order a repeat HbA1C test
D. Refer the client to a dietitian
Correct Answer: B
Expert Rationale: The HbA1C of 8.2% indicates hyperglycemia despite a normal fasting blood
glucose. This discrepancy suggests poor glucose control throughout the day, likely related to
dietary intake or medication adherence. The nurse should first conduct a thorough assessment
of the client's current diet and medication use. The 2026 Polish Federation for Education in
Diabetology (PFED) guidelines emphasize that individualized assessment of lifestyle factors is
essential before making medication changes . The 2026 NICE guidelines also emphasize
collaborative, person-centered target-setting rather than automatically increasing medications .
Increasing the metformin dosage (A) would be premature without assessing non-adherence or
dietary patterns. The 2026 PFED guidelines also highlight that nursing care must integrate
physical, social, and psychological assessments for holistic diabetes management .
4. The nurse is providing discharge teaching to a client with type 2 diabetes and peripheral
neuropathy. Which statement by the client indicates a need for further teaching about injury
prevention?
A. "I should check my shoes for foreign objects before putting them on."
B. "I can break in my shoes by wearing them all day."
C. "I should wear white socks to spot any drainage."
D. "I should inspect my feet daily."
Correct Answer: B
Expert Rationale: Clients with peripheral neuropathy have decreased sensation in their feet and
cannot feel pressure or friction from tight shoes. Wearing new shoes all day to "break them in"
risks developing pressure ulcers or blisters that can become infected and lead to amputation.
The PFED 2026 nursing guidelines recommend that patients with neuropathy should be taught
to inspect their feet daily, wear properly fitting shoes, and avoid soaking feet or walking
barefoot . Options A, C, and D indicate correct understanding of foot care principles.
,5. A client with type 1 diabetes arrives in the emergency department breathing deeply and
stating, "I can't catch my breath." The client's vital signs are: T 98.4°F (36.9°C), P 112 beats/min,
R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action will the
nurse take first?
A. Administer oxygen
B. Check the blood glucose
C. Obtain a chest x-ray
D. Start an IV line
Correct Answer: B
Expert Rationale: The client is exhibiting Kussmaul respirations (deep, rapid breathing) typical of
diabetic ketoacidosis (DKA)—the body's compensatory mechanism for metabolic acidosis. The
vital signs show tachycardia and hypotension, consistent with DKA. The priority is to check the
blood glucose to confirm hyperglycemia and guide immediate treatment. Oxygen (A) is not
indicated with SpO2 99%. Chest x-ray (C) and IV access (D) are important but secondary to
confirming the diagnosis.
6. The clinic nurse is providing teaching to a client with newly diagnosed diabetes. Which
statement by the client indicates a correct understanding about the need to wear a MedicAlert
bracelet?
A. "It will help the hospital staff identify my family."
B. "If I become hypoglycemic, I could become unconscious."
C. "It ensures I receive the correct meal tray."
D. "It is required by the American Diabetes Association."
Correct Answer: B
Expert Rationale: A MedicAlert bracelet provides critical information if the client becomes
unconscious due to severe hypoglycemia, hyperglycemia, or diabetic emergencies. It alerts
healthcare providers to the diagnosis of diabetes, allowing for rapid administration of glucose or
other treatments. The PFED 2026 guidelines recommend that all clients with diabetes,
particularly those on insulin, should wear medical identification .
, 7. The nurse in the endocrine clinic is reviewing type 1 and type 2 diabetes with a group of
nursing students. Which explanation by the students indicates their understanding of the types
of diabetes?
A. "Those with type 1 diabetes make insulin but in inadequate amounts."
B. "Those with type 2 diabetes make insulin, but in inadequate amounts."
C. "Type 1 diabetes can be prevented with proper diet."
D. "Type 2 diabetes only occurs in older adults."
Correct Answer: B
Expert Rationale: Type 2 diabetes involves insulin resistance with relative insulin deficiency—the
pancreas produces insulin but not enough to overcome cellular resistance. In type 1 diabetes,
the pancreas produces little to no insulin due to autoimmune destruction of beta cells. The
2026 NICE guidelines distinguish between these mechanisms for appropriate treatment
selection, with type 2 management involving lifestyle modifications and medications to enhance
insulin sensitivity . Type 1 diabetes is not preventable (C), and type 2 can occur at any age,
including in younger adults (D).
8. Which nursing action will the home health nurse delegate to a home health aide who is
making daily visits to a client with newly diagnosed type 2 diabetes?
A. Assist the client with washing the feet and applying moisturizing lotion
B. Check the client's blood glucose level
C. Administer the client's insulin injection
D. Teach the client about dietary modifications
Correct Answer: A
Expert Rationale: Assisting with foot care (washing and applying lotion) is within the scope of
practice for a home health aide and can be safely delegated. Checking blood glucose (B)
requires a licensed nurse's assessment and interpretation. Insulin administration (C) and client
teaching (D) require licensed nursing judgment. The PFED 2026 nursing guidelines emphasize
that foot care is essential but can be delegated to assistive personnel under the nurse's
supervision .
9. The nurse has just taken change-of-shift report on a group of clients on the medical-surgical
unit. Which client does the nurse assess first?
