N108 Medical-Surgical Nursing — Test 4
Comprehensive Review
Eastwick College | 2026/2027 Updated | 72 Original Practice Questions with Correct Answers,
Detailed Rationales & Nursing Priorities
Coverage: Diabetes Mellitus • Hypoglycemia • DKA • Thyroid Disorders • Metabolic Syndrome
• Diabetes Insipidus • Wound Healing • Pressure Injuries • MRSA • Burns • Musculoskeletal
Disorders • Fractures • Traction • Amputations • Mobility
Section I — Diabetes, Thyroid Disorders and Metabolic
Syndrome
Question 1 — Modifiable Risk Factors for Hyperglycemia
A nurse provides education to an adult patient with prediabetes and a family history of type 2
diabetes mellitus.
Which recommendation best supports long-term glycemic health?
A. Avoid all carbohydrate-containing foods permanently.
B. Maintain regular physical activity, balanced nutrition and prescribed follow-up.
C. Ignore glucose results unless symptoms develop.
D. Stop prescribed medications whenever glucose levels improve.
Correct Answer: B. Maintain regular physical activity, balanced nutrition and prescribed follow-
up.
Rationale: Hyperglycemia occurs when circulating glucose exceeds the body's ability to regulate
it effectively. Insulin resistance, impaired insulin secretion, certain illnesses and medication
effects may contribute.
Regular physical activity, balanced nutrition, sleep management, smoking cessation and
adherence to an individualized treatment plan can improve metabolic health and reduce
cardiovascular risk. Extreme dietary restrictions are not necessary for most patients.
Nursing priority: Assess the patient's knowledge and provide achievable, individualized diabetes-
prevention education.
Question 2 — Systemic Manifestations of Hypoglycemia (Select All That Apply)
,A patient receiving insulin has a blood glucose concentration of 56 mg/dL.
Which findings may occur with hypoglycemia? Select all that apply.
A. Palpitations
B. Trembling and sweating
C. Confusion
D. Sudden hunger
E. Increased mental clarity in every patient
Correct Answers: A, B, C, D
Rationale:
A — Correct: Sympathetic nervous system activation can cause palpitations and
tachycardia.
B — Correct: Tremors and sweating are common autonomic warning signs.
C — Correct: Inadequate glucose delivery to the brain can produce confusion.
D — Correct: Hunger is a recognized hypoglycemic symptom.
E — Incorrect: Hypoglycemia may impair concentration, coordination and
consciousness.
Blood glucose below 70 mg/dL is an important hypoglycemia alert threshold, and values below
54 mg/dL represent clinically significant level 2 hypoglycemia.
American Diabetes Association
Nursing priority: Recognize hypoglycemia promptly, assess the patient's ability to swallow
safely, and follow the prescribed hypoglycemia-management protocol.
Question 3 — Complications of Type 1 Diabetes Mellitus
A 25-year-old patient has lived with type 1 diabetes for several years.
Which condition represents an acute potentially life-threatening complication associated with
insulin deficiency?
A. Diabetic ketoacidosis
B. Osteoarthritis
,C. Cataracts as the only possible complication
D. Uncomplicated seasonal allergies
Correct Answer: A. Diabetic ketoacidosis
Rationale: Type 1 diabetes involves substantial loss of pancreatic beta-cell insulin secretion.
Severe insulin deficiency can increase ketone production and cause metabolic acidosis.
DKA is characterized by diabetes or hyperglycemia, increased ketones and metabolic acidosis.
Long-term complications of diabetes include retinopathy, nephropathy, neuropathy and
cardiovascular disease.
Nursing priority: Recognize symptoms of acute metabolic deterioration and support urgent
assessment of glucose, ketones, hydration, electrolytes and acid–base status.
Question 4 — Type 2 Diabetes: Abnormal Laboratory Values
A patient with established type 2 diabetes has the following laboratory findings:
HbA1c: 9.1%
Fasting plasma glucose: 184 mg/dL
Urine albumin-to-creatinine ratio: 125 mg/g
Which nursing response is most appropriate?
A. Explain that these values demonstrate consistently normal glucose regulation.
B. Review the patient's diabetes-management plan, assess adherence and communicate the
abnormal findings to the clinician.
C. Independently discontinue all diabetes medications.
D. Ignore the increased urine albumin level.
Correct Answer: B. Review the management plan and communicate the findings.
Rationale: An HbA1c of 9.1% suggests elevated average glycemia over approximately the
preceding two to three months.
The fasting glucose concentration is above the normal fasting range. Increased urine albumin
may indicate kidney damage and warrants appropriate evaluation.
Individualized glycemic targets and treatment decisions depend on the patient's clinical
circumstances.
, Nursing priority: Reinforce self-management education, assess for complications and
communicate laboratory abnormalities without independently changing prescribed treatment.
Question 5 — Metabolic Syndrome and Cardiovascular Risk
A patient has elevated blood pressure, increased triglycerides, low HDL cholesterol and elevated
fasting glucose.
Which condition best describes this combination?
A. Metabolic syndrome
B. Isolated hypothyroidism
C. Diabetes insipidus
D. Acute hypoglycemia
Correct Answer: A. Metabolic syndrome
Rationale: Metabolic syndrome is a cluster of cardiometabolic abnormalities that increase the
risk of type 2 diabetes and cardiovascular disease.
The diagnostic framework typically requires at least three of five findings: increased waist
circumference, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure and
increased fasting glucose.
The uploaded notes include BMI as an additional criterion, but standard definitions generally use
waist circumference rather than BMI as one of the five core criteria.
NHLBI, NIH
Nursing priority: Reinforce prescribed monitoring, nutrition and activity recommendations,
smoking cessation and management of cardiovascular risk factors.
Question 6 — Laboratory Findings in Primary Hypothyroidism
A patient complains of fatigue, constipation, cold intolerance and dry skin.
Which laboratory pattern best supports primary hypothyroidism?
A. Reduced TSH with elevated free T4
B. Elevated TSH with reduced free T4
Comprehensive Review
Eastwick College | 2026/2027 Updated | 72 Original Practice Questions with Correct Answers,
Detailed Rationales & Nursing Priorities
Coverage: Diabetes Mellitus • Hypoglycemia • DKA • Thyroid Disorders • Metabolic Syndrome
• Diabetes Insipidus • Wound Healing • Pressure Injuries • MRSA • Burns • Musculoskeletal
Disorders • Fractures • Traction • Amputations • Mobility
Section I — Diabetes, Thyroid Disorders and Metabolic
Syndrome
Question 1 — Modifiable Risk Factors for Hyperglycemia
A nurse provides education to an adult patient with prediabetes and a family history of type 2
diabetes mellitus.
Which recommendation best supports long-term glycemic health?
A. Avoid all carbohydrate-containing foods permanently.
B. Maintain regular physical activity, balanced nutrition and prescribed follow-up.
C. Ignore glucose results unless symptoms develop.
D. Stop prescribed medications whenever glucose levels improve.
Correct Answer: B. Maintain regular physical activity, balanced nutrition and prescribed follow-
up.
Rationale: Hyperglycemia occurs when circulating glucose exceeds the body's ability to regulate
it effectively. Insulin resistance, impaired insulin secretion, certain illnesses and medication
effects may contribute.
Regular physical activity, balanced nutrition, sleep management, smoking cessation and
adherence to an individualized treatment plan can improve metabolic health and reduce
cardiovascular risk. Extreme dietary restrictions are not necessary for most patients.
Nursing priority: Assess the patient's knowledge and provide achievable, individualized diabetes-
prevention education.
Question 2 — Systemic Manifestations of Hypoglycemia (Select All That Apply)
,A patient receiving insulin has a blood glucose concentration of 56 mg/dL.
Which findings may occur with hypoglycemia? Select all that apply.
A. Palpitations
B. Trembling and sweating
C. Confusion
D. Sudden hunger
E. Increased mental clarity in every patient
Correct Answers: A, B, C, D
Rationale:
A — Correct: Sympathetic nervous system activation can cause palpitations and
tachycardia.
B — Correct: Tremors and sweating are common autonomic warning signs.
C — Correct: Inadequate glucose delivery to the brain can produce confusion.
D — Correct: Hunger is a recognized hypoglycemic symptom.
E — Incorrect: Hypoglycemia may impair concentration, coordination and
consciousness.
Blood glucose below 70 mg/dL is an important hypoglycemia alert threshold, and values below
54 mg/dL represent clinically significant level 2 hypoglycemia.
American Diabetes Association
Nursing priority: Recognize hypoglycemia promptly, assess the patient's ability to swallow
safely, and follow the prescribed hypoglycemia-management protocol.
Question 3 — Complications of Type 1 Diabetes Mellitus
A 25-year-old patient has lived with type 1 diabetes for several years.
Which condition represents an acute potentially life-threatening complication associated with
insulin deficiency?
A. Diabetic ketoacidosis
B. Osteoarthritis
,C. Cataracts as the only possible complication
D. Uncomplicated seasonal allergies
Correct Answer: A. Diabetic ketoacidosis
Rationale: Type 1 diabetes involves substantial loss of pancreatic beta-cell insulin secretion.
Severe insulin deficiency can increase ketone production and cause metabolic acidosis.
DKA is characterized by diabetes or hyperglycemia, increased ketones and metabolic acidosis.
Long-term complications of diabetes include retinopathy, nephropathy, neuropathy and
cardiovascular disease.
Nursing priority: Recognize symptoms of acute metabolic deterioration and support urgent
assessment of glucose, ketones, hydration, electrolytes and acid–base status.
Question 4 — Type 2 Diabetes: Abnormal Laboratory Values
A patient with established type 2 diabetes has the following laboratory findings:
HbA1c: 9.1%
Fasting plasma glucose: 184 mg/dL
Urine albumin-to-creatinine ratio: 125 mg/g
Which nursing response is most appropriate?
A. Explain that these values demonstrate consistently normal glucose regulation.
B. Review the patient's diabetes-management plan, assess adherence and communicate the
abnormal findings to the clinician.
C. Independently discontinue all diabetes medications.
D. Ignore the increased urine albumin level.
Correct Answer: B. Review the management plan and communicate the findings.
Rationale: An HbA1c of 9.1% suggests elevated average glycemia over approximately the
preceding two to three months.
The fasting glucose concentration is above the normal fasting range. Increased urine albumin
may indicate kidney damage and warrants appropriate evaluation.
Individualized glycemic targets and treatment decisions depend on the patient's clinical
circumstances.
, Nursing priority: Reinforce self-management education, assess for complications and
communicate laboratory abnormalities without independently changing prescribed treatment.
Question 5 — Metabolic Syndrome and Cardiovascular Risk
A patient has elevated blood pressure, increased triglycerides, low HDL cholesterol and elevated
fasting glucose.
Which condition best describes this combination?
A. Metabolic syndrome
B. Isolated hypothyroidism
C. Diabetes insipidus
D. Acute hypoglycemia
Correct Answer: A. Metabolic syndrome
Rationale: Metabolic syndrome is a cluster of cardiometabolic abnormalities that increase the
risk of type 2 diabetes and cardiovascular disease.
The diagnostic framework typically requires at least three of five findings: increased waist
circumference, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure and
increased fasting glucose.
The uploaded notes include BMI as an additional criterion, but standard definitions generally use
waist circumference rather than BMI as one of the five core criteria.
NHLBI, NIH
Nursing priority: Reinforce prescribed monitoring, nutrition and activity recommendations,
smoking cessation and management of cardiovascular risk factors.
Question 6 — Laboratory Findings in Primary Hypothyroidism
A patient complains of fatigue, constipation, cold intolerance and dry skin.
Which laboratory pattern best supports primary hypothyroidism?
A. Reduced TSH with elevated free T4
B. Elevated TSH with reduced free T4
