NSG223 / NSG 223 EXAM 2 (LATEST )
Medical-Surgical Nursing II | Questions and Verified Answers | 100% Correct | Grade A
Herzing University | Aligned with QSEN Competencies and Med-Surg Practice Guidelines
SECTION 1: Endocrine Disorders (Q1-Q15)
Q1: A nurse is reviewing the diagnostic criteria for diabetes mellitus with a nursing student. Which of the following
laboratory values confirms a diagnosis of diabetes mellitus?
A. Fasting plasma glucose (FPG) of 110 mg/dL
B. Hemoglobin A1C of 5.8%
C. Fasting plasma glucose (FPG) of 130 mg/dL [CORRECT]
D. 2-hour postprandial glucose of 160 mg/dL
Correct Answer: C
Rationale: A fasting plasma glucose >= 126 mg/dL on two separate occasions confirms a diagnosis of diabetes mellitus. An FPG
of 110 mg/dL falls in the impaired fasting glucose range (100-125 mg/dL), not diagnostic. An A1C of 5.8% is below the
diagnostic threshold of >= 6.5%. A 2-hour postprandial glucose of 160 mg/dL during an OGTT is below the diagnostic threshold
of >= 200 mg/dL.
Q2: A nurse is providing discharge teaching to a client newly diagnosed with Type 1 diabetes mellitus. Which
statement by the client indicates an understanding of the disease process?
A. My pancreas still makes insulin, but my body does not use it effectively.
B. I will need to take oral metformin every day to control my blood glucose.
C. My body has destroyed the beta cells in my pancreas, so I need lifelong insulin therapy. [CORRECT]
D. If I lose weight and exercise, I may not need insulin injections anymore.
Correct Answer: C
Rationale: Type 1 diabetes results from autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency
requiring lifelong exogenous insulin. Option A describes Type 2 diabetes (insulin resistance), not Type 1. Metformin is an oral
hypoglycemic used for Type 2 diabetes; clients with Type 1 require insulin. While lifestyle modifications are important, they cannot
restore destroyed beta cells in Type 1 diabetes.
Q3: A nurse is reviewing insulin types with a client who has Type 1 diabetes. The client asks which insulin type can be
administered intravenously. Which response by the nurse is correct?
A. Glargine can be given intravenously in an emergency.
B. Only regular insulin can be administered intravenously. [CORRECT]
C. Both regular insulin and insulin lispro can be given intravenously.
D. No insulin formulations are safe for intravenous administration.
Correct Answer: B
Rationale: Only regular insulin is safe for intravenous administration. Regular insulin is a short-acting insulin with an onset of
30-60 minutes, peak of 2-4 hours, and duration of 5-7 hours. It is the only insulin used for IV insulin drips, such as in DKA
management. Long-acting insulins (glargine, detemir) and rapid-acting analogs (lispro, aspart) are never given intravenously as
they can cause dangerous hypoglycemia and unpredictable effects.
,NSG223 Medical-Surgical Nursing II Exam 2 | Herzing University 2026/2027 Updated
Q4: A client with Type 2 diabetes mellitus is prescribed metformin. The nurse should teach the client to monitor for
which potential adverse effect?
A. Hypoglycemia when meals are skipped
B. Lactic acidosis with symptoms of muscle pain and malaise [CORRECT]
C. Weight gain of 5 to 10 pounds over several months
D. Excessive urinary potassium excretion
Correct Answer: B
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but life-threatening complication characterized by
muscle pain, respiratory distress, extreme fatigue, and malaise. Unlike sulfonylureas or insulin, metformin monotherapy rarely
causes hypoglycemia because it does not stimulate insulin secretion. Metformin is actually weight-neutral or associated with mild
weight loss, not weight gain. It does not cause excessive potassium excretion.
Q5: A client with Type 2 diabetes is taking glipizide, a sulfonylurea. The client reports feeling shaky, diaphoretic, and
irritable. The blood glucose is 58 mg/dL. The nurse understands that sulfonylureas lower blood glucose by which
mechanism?
A. Decreasing hepatic glucose production and increasing insulin sensitivity
B. Blocking glucose reabsorption in the kidneys
C. Stimulating the pancreas to release more insulin [CORRECT]
D. Delaying gastric emptying and slowing carbohydrate absorption
Correct Answer: C
Rationale: Sulfonylureas (glipizide, glyburide, glimepiride) lower blood glucose by stimulating pancreatic beta cells to release more
insulin. This mechanism puts clients at risk for hypoglycemia, especially if meals are skipped or delayed. Decreasing hepatic
glucose production and increasing insulin sensitivity describes metformin. Blocking glucose reabsorption in the kidneys describes
SGLT2 inhibitors. Delaying gastric emptying describes GLP-1 receptor agonists.
Q6: A client arrives at the emergency department with Kussmaul respirations, a blood glucose of 320 mg/dL, blood
pH of 7.25, and serum bicarbonate of 12 mEq/L. The nurse identifies these findings as consistent with which
condition?
A. Hyperosmolar hyperglycemic syndrome (HHS)
B. Diabetic ketoacidosis (DKA) [CORRECT]
C. Hypoglycemic unawareness
D. Thyroid storm
Correct Answer: B
Rationale: DKA is characterized by the triad of hyperglycemia (typically > 250 mg/dL), ketosis, and metabolic acidosis (pH < 7.3,
HCO3 < 15 mEq/L). Kussmaul respirations (deep, rapid breathing) are the body's compensatory mechanism to exhale CO2 and
correct metabolic acidosis. HHS presents with much higher blood glucose (> 600 mg/dL) and severe dehydration but without
ketosis or significant acidosis. Hypoglycemic unawareness and thyroid storm do not produce these laboratory findings.
Q7: A nurse is caring for a client admitted with diabetic ketoacidosis (DKA). The initial serum potassium is 3.2
mEq/L. Which intervention should the nurse anticipate?
A. Begin intravenous regular insulin infusion at 0.1 units/kg/hr immediately
B. Administer intravenous 0.9% normal saline and hold insulin until potassium is corrected [CORRECT]
C. Initiate potassium replacement and begin insulin therapy concurrently
D. Administer sodium bicarbonate intravenously to correct the acidosis first
Correct Answer: B
Rationale: When serum potassium is below 3.3 mEq/L, insulin must be held and potassium replaced first. Insulin drives potassium
intracellularly and would cause dangerous hypokalemia if given with a low serum potassium. Once potassium is >= 3.3 mEq/L,
Page 2
, NSG223 Medical-Surgical Nursing II Exam 2 | Herzing University 2026/2027 Updated
insulin therapy can begin. IV normal saline is also needed for fluid resuscitation but potassium correction takes priority before
starting insulin. Sodium bicarbonate is reserved for severe acidosis (pH < 6.9).
Q8: A nurse is differentiating between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome
(HHS). Which finding is unique to HHS compared to DKA?
A. Blood glucose level greater than 600 mg/dL
B. Profound dehydration with serum osmolality greater than 320 mOsm/kg
C. Absence of ketone bodies in blood and urine [CORRECT]
D. Altered mental status ranging from confusion to coma
Correct Answer: C
Rationale: The key distinguishing feature of HHS is the absence of ketosis, whereas DKA always involves ketone body production.
While HHS typically presents with much higher blood glucose (> 600 mg/dL versus > 250 mg/dL in DKA) and more profound
dehydration, the absence of ketones is the hallmark differentiator. Both DKA and HHS can cause altered mental status, though it
is more common and severe in HHS due to extreme hyperosmolality. Profound dehydration occurs in both conditions.
Q9: A client with Type 2 diabetes is found unconscious with a blood glucose of 52 mg/dL. After ensuring a patent
airway, which action should the nurse take?
A. Administer 15 grams of fast-acting carbohydrate orally
B. Administer 1 mg of glucagon intramuscularly [CORRECT]
C. Give 4 oz of fruit juice via a straw
D. Apply a continuous glucose monitor for ongoing surveillance
Correct Answer: B
Rationale: An unconscious client with hypoglycemia (blood glucose < 70 mg/dL) must not receive anything by mouth due to
aspiration risk. The nurse should administer glucagon 1 mg IM or nasal glucagon to rapidly raise blood glucose. Oral
carbohydrates follow the Rule of 15s (15 g fast-acting carbohydrate, recheck in 15 minutes, repeat if below 70 mg/dL) but are
only appropriate for conscious clients. A continuous glucose monitor does not treat the acute hypoglycemic emergency.
Q10: A nurse is assessing a client with Graves' disease. Which of the following findings should the nurse expect?
A. Weight gain and cold intolerance
B. Exophthalmos and lid lag [CORRECT]
C. Tremors and heat intolerance
D. Bradycardia and dry skin
Correct Answer: B
Rationale: Graves' disease is the most common cause of hyperthyroidism, producing a hypermetabolic state. Exophthalmos
(protruding eyes) and lid lag are classic eye findings specific to Graves' disease. While tremors and heat intolerance also occur in
hyperthyroidism, exophthalmos and lid lag are the most distinctive findings for Graves' specifically. Weight gain, cold intolerance,
bradycardia, and dry skin are manifestations of hypothyroidism, not hyperthyroidism.
Q11: A client with hyperthyroidism is discussing treatment options with the nurse. The client asks about the purpose
of taking a beta-blocker. Which response by the nurse is accurate?
A. Beta-blockers cure hyperthyroidism by reducing thyroid hormone production.
B. Beta-blockers control sympathetic symptoms such as tachycardia, tremor, and anxiety. [CORRECT]
C. Beta-blockers replace the need for antithyroid medications like methimazole.
D. Beta-blockers destroy overactive thyroid tissue similar to radioactive iodine.
Correct Answer: B
Rationale: Beta-blockers (such as propranolol) are used as adjunctive therapy in hyperthyroidism to manage sympathetic nervous
system symptoms including tachycardia, palpitations, tremor, and anxiety. They do not treat the underlying thyroid dysfunction.
Page 3
Medical-Surgical Nursing II | Questions and Verified Answers | 100% Correct | Grade A
Herzing University | Aligned with QSEN Competencies and Med-Surg Practice Guidelines
SECTION 1: Endocrine Disorders (Q1-Q15)
Q1: A nurse is reviewing the diagnostic criteria for diabetes mellitus with a nursing student. Which of the following
laboratory values confirms a diagnosis of diabetes mellitus?
A. Fasting plasma glucose (FPG) of 110 mg/dL
B. Hemoglobin A1C of 5.8%
C. Fasting plasma glucose (FPG) of 130 mg/dL [CORRECT]
D. 2-hour postprandial glucose of 160 mg/dL
Correct Answer: C
Rationale: A fasting plasma glucose >= 126 mg/dL on two separate occasions confirms a diagnosis of diabetes mellitus. An FPG
of 110 mg/dL falls in the impaired fasting glucose range (100-125 mg/dL), not diagnostic. An A1C of 5.8% is below the
diagnostic threshold of >= 6.5%. A 2-hour postprandial glucose of 160 mg/dL during an OGTT is below the diagnostic threshold
of >= 200 mg/dL.
Q2: A nurse is providing discharge teaching to a client newly diagnosed with Type 1 diabetes mellitus. Which
statement by the client indicates an understanding of the disease process?
A. My pancreas still makes insulin, but my body does not use it effectively.
B. I will need to take oral metformin every day to control my blood glucose.
C. My body has destroyed the beta cells in my pancreas, so I need lifelong insulin therapy. [CORRECT]
D. If I lose weight and exercise, I may not need insulin injections anymore.
Correct Answer: C
Rationale: Type 1 diabetes results from autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency
requiring lifelong exogenous insulin. Option A describes Type 2 diabetes (insulin resistance), not Type 1. Metformin is an oral
hypoglycemic used for Type 2 diabetes; clients with Type 1 require insulin. While lifestyle modifications are important, they cannot
restore destroyed beta cells in Type 1 diabetes.
Q3: A nurse is reviewing insulin types with a client who has Type 1 diabetes. The client asks which insulin type can be
administered intravenously. Which response by the nurse is correct?
A. Glargine can be given intravenously in an emergency.
B. Only regular insulin can be administered intravenously. [CORRECT]
C. Both regular insulin and insulin lispro can be given intravenously.
D. No insulin formulations are safe for intravenous administration.
Correct Answer: B
Rationale: Only regular insulin is safe for intravenous administration. Regular insulin is a short-acting insulin with an onset of
30-60 minutes, peak of 2-4 hours, and duration of 5-7 hours. It is the only insulin used for IV insulin drips, such as in DKA
management. Long-acting insulins (glargine, detemir) and rapid-acting analogs (lispro, aspart) are never given intravenously as
they can cause dangerous hypoglycemia and unpredictable effects.
,NSG223 Medical-Surgical Nursing II Exam 2 | Herzing University 2026/2027 Updated
Q4: A client with Type 2 diabetes mellitus is prescribed metformin. The nurse should teach the client to monitor for
which potential adverse effect?
A. Hypoglycemia when meals are skipped
B. Lactic acidosis with symptoms of muscle pain and malaise [CORRECT]
C. Weight gain of 5 to 10 pounds over several months
D. Excessive urinary potassium excretion
Correct Answer: B
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but life-threatening complication characterized by
muscle pain, respiratory distress, extreme fatigue, and malaise. Unlike sulfonylureas or insulin, metformin monotherapy rarely
causes hypoglycemia because it does not stimulate insulin secretion. Metformin is actually weight-neutral or associated with mild
weight loss, not weight gain. It does not cause excessive potassium excretion.
Q5: A client with Type 2 diabetes is taking glipizide, a sulfonylurea. The client reports feeling shaky, diaphoretic, and
irritable. The blood glucose is 58 mg/dL. The nurse understands that sulfonylureas lower blood glucose by which
mechanism?
A. Decreasing hepatic glucose production and increasing insulin sensitivity
B. Blocking glucose reabsorption in the kidneys
C. Stimulating the pancreas to release more insulin [CORRECT]
D. Delaying gastric emptying and slowing carbohydrate absorption
Correct Answer: C
Rationale: Sulfonylureas (glipizide, glyburide, glimepiride) lower blood glucose by stimulating pancreatic beta cells to release more
insulin. This mechanism puts clients at risk for hypoglycemia, especially if meals are skipped or delayed. Decreasing hepatic
glucose production and increasing insulin sensitivity describes metformin. Blocking glucose reabsorption in the kidneys describes
SGLT2 inhibitors. Delaying gastric emptying describes GLP-1 receptor agonists.
Q6: A client arrives at the emergency department with Kussmaul respirations, a blood glucose of 320 mg/dL, blood
pH of 7.25, and serum bicarbonate of 12 mEq/L. The nurse identifies these findings as consistent with which
condition?
A. Hyperosmolar hyperglycemic syndrome (HHS)
B. Diabetic ketoacidosis (DKA) [CORRECT]
C. Hypoglycemic unawareness
D. Thyroid storm
Correct Answer: B
Rationale: DKA is characterized by the triad of hyperglycemia (typically > 250 mg/dL), ketosis, and metabolic acidosis (pH < 7.3,
HCO3 < 15 mEq/L). Kussmaul respirations (deep, rapid breathing) are the body's compensatory mechanism to exhale CO2 and
correct metabolic acidosis. HHS presents with much higher blood glucose (> 600 mg/dL) and severe dehydration but without
ketosis or significant acidosis. Hypoglycemic unawareness and thyroid storm do not produce these laboratory findings.
Q7: A nurse is caring for a client admitted with diabetic ketoacidosis (DKA). The initial serum potassium is 3.2
mEq/L. Which intervention should the nurse anticipate?
A. Begin intravenous regular insulin infusion at 0.1 units/kg/hr immediately
B. Administer intravenous 0.9% normal saline and hold insulin until potassium is corrected [CORRECT]
C. Initiate potassium replacement and begin insulin therapy concurrently
D. Administer sodium bicarbonate intravenously to correct the acidosis first
Correct Answer: B
Rationale: When serum potassium is below 3.3 mEq/L, insulin must be held and potassium replaced first. Insulin drives potassium
intracellularly and would cause dangerous hypokalemia if given with a low serum potassium. Once potassium is >= 3.3 mEq/L,
Page 2
, NSG223 Medical-Surgical Nursing II Exam 2 | Herzing University 2026/2027 Updated
insulin therapy can begin. IV normal saline is also needed for fluid resuscitation but potassium correction takes priority before
starting insulin. Sodium bicarbonate is reserved for severe acidosis (pH < 6.9).
Q8: A nurse is differentiating between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome
(HHS). Which finding is unique to HHS compared to DKA?
A. Blood glucose level greater than 600 mg/dL
B. Profound dehydration with serum osmolality greater than 320 mOsm/kg
C. Absence of ketone bodies in blood and urine [CORRECT]
D. Altered mental status ranging from confusion to coma
Correct Answer: C
Rationale: The key distinguishing feature of HHS is the absence of ketosis, whereas DKA always involves ketone body production.
While HHS typically presents with much higher blood glucose (> 600 mg/dL versus > 250 mg/dL in DKA) and more profound
dehydration, the absence of ketones is the hallmark differentiator. Both DKA and HHS can cause altered mental status, though it
is more common and severe in HHS due to extreme hyperosmolality. Profound dehydration occurs in both conditions.
Q9: A client with Type 2 diabetes is found unconscious with a blood glucose of 52 mg/dL. After ensuring a patent
airway, which action should the nurse take?
A. Administer 15 grams of fast-acting carbohydrate orally
B. Administer 1 mg of glucagon intramuscularly [CORRECT]
C. Give 4 oz of fruit juice via a straw
D. Apply a continuous glucose monitor for ongoing surveillance
Correct Answer: B
Rationale: An unconscious client with hypoglycemia (blood glucose < 70 mg/dL) must not receive anything by mouth due to
aspiration risk. The nurse should administer glucagon 1 mg IM or nasal glucagon to rapidly raise blood glucose. Oral
carbohydrates follow the Rule of 15s (15 g fast-acting carbohydrate, recheck in 15 minutes, repeat if below 70 mg/dL) but are
only appropriate for conscious clients. A continuous glucose monitor does not treat the acute hypoglycemic emergency.
Q10: A nurse is assessing a client with Graves' disease. Which of the following findings should the nurse expect?
A. Weight gain and cold intolerance
B. Exophthalmos and lid lag [CORRECT]
C. Tremors and heat intolerance
D. Bradycardia and dry skin
Correct Answer: B
Rationale: Graves' disease is the most common cause of hyperthyroidism, producing a hypermetabolic state. Exophthalmos
(protruding eyes) and lid lag are classic eye findings specific to Graves' disease. While tremors and heat intolerance also occur in
hyperthyroidism, exophthalmos and lid lag are the most distinctive findings for Graves' specifically. Weight gain, cold intolerance,
bradycardia, and dry skin are manifestations of hypothyroidism, not hyperthyroidism.
Q11: A client with hyperthyroidism is discussing treatment options with the nurse. The client asks about the purpose
of taking a beta-blocker. Which response by the nurse is accurate?
A. Beta-blockers cure hyperthyroidism by reducing thyroid hormone production.
B. Beta-blockers control sympathetic symptoms such as tachycardia, tremor, and anxiety. [CORRECT]
C. Beta-blockers replace the need for antithyroid medications like methimazole.
D. Beta-blockers destroy overactive thyroid tissue similar to radioactive iodine.
Correct Answer: B
Rationale: Beta-blockers (such as propranolol) are used as adjunctive therapy in hyperthyroidism to manage sympathetic nervous
system symptoms including tachycardia, palpitations, tremor, and anxiety. They do not treat the underlying thyroid dysfunction.
Page 3
