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Adult Health Nursing II Exam 1 — Practice Questions with Detailed Rationales
Endocrine & Respiratory Emergencies | 2026–2027 Edition
SECTION 1: DIABETIC KETOACIDOSIS (DKA) — Questions 1–55
Q1. A 23-year-old with type 1 diabetes presents with vomiting,
abdominal pain, and Kussmaul respirations. Labs show glucose
420 mg/dL, pH 7.12, and positive serum ketones. What is the
primary underlying mechanism?
A. Absolute insulin resistance
B. Absolute insulin deficiency leading to lipolysis and
ketogenesis
C. Excess glucagon suppression
D. Renal failure causing glucose retention
Answer: B
Rationale: DKA results from absolute insulin deficiency, leading
to uncontrolled lipolysis, free fatty acid breakdown, and ketone
production causing metabolic acidosis.
Q2. Which lab finding most strongly differentiates DKA from
HHS?
A. Severe hyperglycemia
B. Elevated serum osmolality
C. Presence of significant serum ketones
D. Polyuria
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Answer: C
Rationale: Ketosis and metabolic acidosis are hallmarks of DKA
but are absent or minimal in HHS.
Q3. A patient with HHS is most likely to present with:
A. Fruity breath odor
B. Kussmaul respirations
C. Severe dehydration with neurologic impairment
D. Rapid onset abdominal pain
Answer: C
Rationale: HHS presents with profound dehydration and
altered mental status due to extreme hyperosmolarity, without
significant ketoacidosis.
Q4. Which insulin therapy is most appropriate for initial
management of DKA?
A. Long-acting insulin glargine
B. Subcutaneous sliding scale insulin only
C. Continuous IV regular insulin infusion
D. Intramuscular NPH insulin
Answer: C
Rationale: IV regular insulin allows rapid titration and
suppression of ketogenesis in DKA.
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Q5. A key early priority in both DKA and HHS is:
A. Immediate insulin administration
B. Bicarbonate infusion
C. Aggressive isotonic fluid resuscitation
D. Potassium restriction
Answer: C
Rationale: Fluid replacement is first-line to restore perfusion
and reduce hyperglycemia-induced osmotic diuresis.
Q6. A patient with DKA has a potassium level of 3.0 mEq/L.
What is the appropriate action?
A. Start insulin immediately
B. Administer sodium bicarbonate
C. Hold insulin and replace potassium first
D. Give loop diuretics
Answer: C
Rationale: Insulin drives potassium into cells, worsening
hypokalemia and risking fatal arrhythmias.
Q7. Which condition is most commonly associated with HHS?
A. Type 1 diabetes
B. Alcohol use disorder
C. Type 2 diabetes
D. Addison's disease
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Answer: C
Rationale: HHS typically occurs in type 2 diabetes with relative
insulin deficiency.
Q8. Which acid-base disturbance is expected in DKA?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. High anion gap metabolic acidosis
D. Normal anion gap metabolic acidosis
Answer: C
Rationale: Ketone accumulation produces organic acids,
increasing anion gap metabolic acidosis.
Q9. Which symptom is more specific to DKA than HHS?
A. Polyuria
B. Dehydration
C. Kussmaul respirations
D. Confusion
Answer: C
Rationale: Kussmaul respirations are compensatory deep
breathing due to metabolic acidosis.
Q10. Which serum osmolality finding is most consistent with
HHS?
Adult Health Nursing II Exam 1 — Practice Questions with Detailed Rationales
Endocrine & Respiratory Emergencies | 2026–2027 Edition
SECTION 1: DIABETIC KETOACIDOSIS (DKA) — Questions 1–55
Q1. A 23-year-old with type 1 diabetes presents with vomiting,
abdominal pain, and Kussmaul respirations. Labs show glucose
420 mg/dL, pH 7.12, and positive serum ketones. What is the
primary underlying mechanism?
A. Absolute insulin resistance
B. Absolute insulin deficiency leading to lipolysis and
ketogenesis
C. Excess glucagon suppression
D. Renal failure causing glucose retention
Answer: B
Rationale: DKA results from absolute insulin deficiency, leading
to uncontrolled lipolysis, free fatty acid breakdown, and ketone
production causing metabolic acidosis.
Q2. Which lab finding most strongly differentiates DKA from
HHS?
A. Severe hyperglycemia
B. Elevated serum osmolality
C. Presence of significant serum ketones
D. Polyuria
, Page |2
Answer: C
Rationale: Ketosis and metabolic acidosis are hallmarks of DKA
but are absent or minimal in HHS.
Q3. A patient with HHS is most likely to present with:
A. Fruity breath odor
B. Kussmaul respirations
C. Severe dehydration with neurologic impairment
D. Rapid onset abdominal pain
Answer: C
Rationale: HHS presents with profound dehydration and
altered mental status due to extreme hyperosmolarity, without
significant ketoacidosis.
Q4. Which insulin therapy is most appropriate for initial
management of DKA?
A. Long-acting insulin glargine
B. Subcutaneous sliding scale insulin only
C. Continuous IV regular insulin infusion
D. Intramuscular NPH insulin
Answer: C
Rationale: IV regular insulin allows rapid titration and
suppression of ketogenesis in DKA.
, Page |3
Q5. A key early priority in both DKA and HHS is:
A. Immediate insulin administration
B. Bicarbonate infusion
C. Aggressive isotonic fluid resuscitation
D. Potassium restriction
Answer: C
Rationale: Fluid replacement is first-line to restore perfusion
and reduce hyperglycemia-induced osmotic diuresis.
Q6. A patient with DKA has a potassium level of 3.0 mEq/L.
What is the appropriate action?
A. Start insulin immediately
B. Administer sodium bicarbonate
C. Hold insulin and replace potassium first
D. Give loop diuretics
Answer: C
Rationale: Insulin drives potassium into cells, worsening
hypokalemia and risking fatal arrhythmias.
Q7. Which condition is most commonly associated with HHS?
A. Type 1 diabetes
B. Alcohol use disorder
C. Type 2 diabetes
D. Addison's disease
, Page |4
Answer: C
Rationale: HHS typically occurs in type 2 diabetes with relative
insulin deficiency.
Q8. Which acid-base disturbance is expected in DKA?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. High anion gap metabolic acidosis
D. Normal anion gap metabolic acidosis
Answer: C
Rationale: Ketone accumulation produces organic acids,
increasing anion gap metabolic acidosis.
Q9. Which symptom is more specific to DKA than HHS?
A. Polyuria
B. Dehydration
C. Kussmaul respirations
D. Confusion
Answer: C
Rationale: Kussmaul respirations are compensatory deep
breathing due to metabolic acidosis.
Q10. Which serum osmolality finding is most consistent with
HHS?
