,NURS 480 exam 3 Advanced Medical Surgical Nursing Questions And
Answers 2026/2027 West Coast University
Q1. A client with type 2 diabetes presents with profound weakness, polyuria,
dry mucous membranes, a glucose level of 890 mg/dL, serum osmolality of
345 mOsm/kg, and minimal ketones. Which intervention is the priority?
A. Administer IV sodium bicarbonate
B. Begin isotonic IV fluid replacement
C. Restrict fluids
D. Administer long-acting subcutaneous insulin
Correct Answer: B
Rationale: Hyperosmolar hyperglycemic state causes profound dehydration.
Initial treatment focuses on restoring intravascular volume with isotonic
fluids.
Q2. Which finding is most characteristic of hyperosmolar hyperglycemic
state?
A. Severe hyperglycemia with profound dehydration and minimal ketosis
B. Severe metabolic acidosis with large ketone production
C. Persistent hypoglycemia
D. Respiratory alkalosis with normal glucose
Correct Answer: A
Rationale: HHS is characterized by extreme hyperglycemia,
hyperosmolality, and significant water loss with little or no ketoacidosis.
Q3. Which client is at greatest risk for developing HHS?
A. Older adult with type 2 diabetes and infection
B. Healthy adolescent without diabetes
C. Adult with isolated hypothyroidism
D. Client with mild anemia
Correct Answer: A
Rationale: HHS commonly occurs in older adults with type 2 diabetes and
may be precipitated by infection, illness, or inadequate fluid intake.
Q4. A client with HHS is receiving IV fluids and insulin. Which laboratory
value requires close monitoring?
, A. Serum potassium
B. Hemoglobin A1c only
C. Total cholesterol
D. Hemoglobin
Correct Answer: A
Rationale: Insulin drives potassium into cells, which can cause a significant
fall in serum potassium during treatment.
Q5. A client with DKA has a potassium level of 3.1 mEq/L. Which action
should the nurse anticipate?
A. Begin potassium replacement as prescribed before insulin is initiated or
continued according to protocol.
B. Administer additional insulin immediately without addressing potassium.
C. Restrict potassium.
D. Administer sodium bicarbonate routinely.
Correct Answer: A
Rationale: Insulin further lowers serum potassium by shifting it
intracellularly. Significant hypokalemia must be corrected to reduce the risk
of dangerous dysrhythmias.
Q6. Which finding is characteristic of diabetic ketoacidosis?
A. Kussmaul respirations
B. Minimal ketones
C. Normal acid-base status
D. Severe hypernatremia without dehydration
Correct Answer: A
Rationale: DKA causes metabolic acidosis, and Kussmaul respirations are
compensatory deep, rapid respirations.
Q7. Which assessment finding is most concerning in a client with DKA?
A. Decreasing level of consciousness
B. Mild thirst
C. Dry lips
D. Increased appetite
Correct Answer: A
Answers 2026/2027 West Coast University
Q1. A client with type 2 diabetes presents with profound weakness, polyuria,
dry mucous membranes, a glucose level of 890 mg/dL, serum osmolality of
345 mOsm/kg, and minimal ketones. Which intervention is the priority?
A. Administer IV sodium bicarbonate
B. Begin isotonic IV fluid replacement
C. Restrict fluids
D. Administer long-acting subcutaneous insulin
Correct Answer: B
Rationale: Hyperosmolar hyperglycemic state causes profound dehydration.
Initial treatment focuses on restoring intravascular volume with isotonic
fluids.
Q2. Which finding is most characteristic of hyperosmolar hyperglycemic
state?
A. Severe hyperglycemia with profound dehydration and minimal ketosis
B. Severe metabolic acidosis with large ketone production
C. Persistent hypoglycemia
D. Respiratory alkalosis with normal glucose
Correct Answer: A
Rationale: HHS is characterized by extreme hyperglycemia,
hyperosmolality, and significant water loss with little or no ketoacidosis.
Q3. Which client is at greatest risk for developing HHS?
A. Older adult with type 2 diabetes and infection
B. Healthy adolescent without diabetes
C. Adult with isolated hypothyroidism
D. Client with mild anemia
Correct Answer: A
Rationale: HHS commonly occurs in older adults with type 2 diabetes and
may be precipitated by infection, illness, or inadequate fluid intake.
Q4. A client with HHS is receiving IV fluids and insulin. Which laboratory
value requires close monitoring?
, A. Serum potassium
B. Hemoglobin A1c only
C. Total cholesterol
D. Hemoglobin
Correct Answer: A
Rationale: Insulin drives potassium into cells, which can cause a significant
fall in serum potassium during treatment.
Q5. A client with DKA has a potassium level of 3.1 mEq/L. Which action
should the nurse anticipate?
A. Begin potassium replacement as prescribed before insulin is initiated or
continued according to protocol.
B. Administer additional insulin immediately without addressing potassium.
C. Restrict potassium.
D. Administer sodium bicarbonate routinely.
Correct Answer: A
Rationale: Insulin further lowers serum potassium by shifting it
intracellularly. Significant hypokalemia must be corrected to reduce the risk
of dangerous dysrhythmias.
Q6. Which finding is characteristic of diabetic ketoacidosis?
A. Kussmaul respirations
B. Minimal ketones
C. Normal acid-base status
D. Severe hypernatremia without dehydration
Correct Answer: A
Rationale: DKA causes metabolic acidosis, and Kussmaul respirations are
compensatory deep, rapid respirations.
Q7. Which assessment finding is most concerning in a client with DKA?
A. Decreasing level of consciousness
B. Mild thirst
C. Dry lips
D. Increased appetite
Correct Answer: A
