PNH301 Test 2 ACTUAL EXAM 2026/2027 |
PNH301 Nursing Concepts | Verified Q&A |
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Section 1: Endocrine Disorders & Pharmacotherapy
Q1: A patient with Type 2 diabetes has a HbA1c of 9.2% (target <7%) despite taking metformin 1000 mg
BID. The physician adds sitagliptin. What is the mechanism of action of sitagliptin?
A. Increases insulin secretion by closing ATP-sensitive K+ channels in pancreatic beta cells
B. Increases GLP-1 levels by inhibiting dipeptidyl peptidase-4 (DPP-4) [CORRECT]
C. Reduces hepatic glucose production and increases peripheral glucose uptake
D. Increases urinary glucose excretion by inhibiting SGLT2 in renal tubules
Correct Answer: B
Rationale: [CORRECT] Sitagliptin is a DPP-4 inhibitor; it blocks the enzyme that breaks down incretin
hormones like GLP-1. This prolongs the action of GLP-1, stimulating glucose-dependent insulin release
and suppressing glucagon.
A – This describes the mechanism of sulfonylureas (e.g., glipizide, glyburide).
C – This describes the mechanism of biguanides (metformin).
D – This describes the mechanism of SGLT2 inhibitors (e.g., empagliflozin, canagliflozin).
Q2: A patient with Addison's disease is admitted with hypotension, hyponatremia, hyperkalemia, and
hypoglycemia. Which medication should the nurse prepare to administer FIRST?
A. Fludrocortisone
B. Hydrocortisone IV [CORRECT]
C. Spironolactone
D. 10% dextrose IV
,Correct Answer: B
Rationale: [CORRECT] This patient is in acute adrenal crisis (Addisonian crisis). The priority is IV
glucocorticoid (hydrocortisone) replacement to restore vascular tone, blood pressure, and correct
metabolic imbalances. High-dose hydrocortisone has sufficient mineralocorticoid activity to correct
hyperkalemia and hyponatremia initially.
A – Fludrocortisone is a mineralocorticoid used for chronic maintenance; it lacks the glucocorticoid
potency needed for acute shock.
C – Spironolactone is a potassium-sparing diuretic; it is contraindicated as the patient is already
hyperkalemic.
D – While dextrose treats hypoglycemia, the primary driver of shock is cortisol deficiency;
hydrocortisone addresses both the hypotension and the hypoglycemia.
Q3: A patient is prescribed levothyroxine (Synthroid) for hypothyroidism. Which instruction is most
critical for the nurse to include in the discharge teaching?
A. "Take the medication with breakfast to ensure absorption."
B. "Take the medication on an empty stomach, 30–60 minutes before breakfast." [CORRECT]
C. "Avoid foods high in iodine, such as seafood."
D. "Stop the medication immediately if you experience palpitations."
Correct Answer: B
Rationale: [CORRECT] Levothyroxine absorption is decreased by food, calcium, and iron. It must be taken
on an empty stomach consistently to maintain stable thyroid levels.
A – Food decreases absorption; taking it with breakfast reduces efficacy.
C – Iodine is not restricted in hypothyroid patients taking levothyroxine.
D – Palpitations may indicate toxicity, but the patient should contact the provider for dose adjustment
rather than stopping abruptly.
Q4: The nurse is caring for a patient with diabetic ketoacidosis (DKA). The patient's initial lab results
include: pH 7.20, PaCO2 28 mmHg, HCO3 12 mEq/L, and serum potassium 5.8 mEq/L. As insulin therapy
is initiated, what is the nurse's priority intervention regarding potassium?
A. Hold insulin if potassium is >5.0 mEq/L.
, B. Monitor for signs of hypokalemia and anticipate IV potassium replacement. [CORRECT]
C. Administer IV potassium immediately before insulin.
D. Administer a potassium-sparing diuretic.
Correct Answer: B
Rationale: [CORRECT] Although the initial potassium is high due to acidosis (H+-K+ shift) and renal
failure, insulin drives potassium back into cells, causing a rapid drop. As acidosis corrects and fluids
dilute the potassium, severe hypokalemia is a major risk.
A – Insulin is the treatment for DKA; it should not be held, but potassium must be monitored closely.
C – Giving potassium when the serum level is 5.8 mEq/L would be dangerous (hyperkalemia risk).
D – Potassium-sparing diuretics are contraindicated in renal failure and hyperkalemia.
Q5: A patient with Cushing's syndrome is admitted for an adrenalectomy. Which preoperative
assessment finding is most concerning to the nurse?
A. Moon face and buffalo hump.
B. Serum glucose of 180 mg/dL.
C. Serum potassium of 3.0 mEq/L. [CORRECT]
D. Blood pressure of 150/90 mm Hg.
Correct Answer: C
Rationale: [CORRECT] Cushing's syndrome involves excess cortisol (glucocorticoid) and often
aldosterone (mineralocorticoid). This leads to sodium retention and potassium excretion (hypokalemia).
Hypokalemia increases the risk of cardiac dysrhythmias, especially during surgery.
A, B, D – These are expected findings in Cushing's syndrome due to hypercortisolism; while they require
management, hypokalemia poses the most immediate physiological threat.
Q6: A patient is starting metformin. Which condition is a contraindication for this medication?
A. Hypertension
B. Renal impairment (eGFR <30 mL/min) [CORRECT]
C. Hyperlipidemia
PNH301 Nursing Concepts | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Endocrine Disorders & Pharmacotherapy
Q1: A patient with Type 2 diabetes has a HbA1c of 9.2% (target <7%) despite taking metformin 1000 mg
BID. The physician adds sitagliptin. What is the mechanism of action of sitagliptin?
A. Increases insulin secretion by closing ATP-sensitive K+ channels in pancreatic beta cells
B. Increases GLP-1 levels by inhibiting dipeptidyl peptidase-4 (DPP-4) [CORRECT]
C. Reduces hepatic glucose production and increases peripheral glucose uptake
D. Increases urinary glucose excretion by inhibiting SGLT2 in renal tubules
Correct Answer: B
Rationale: [CORRECT] Sitagliptin is a DPP-4 inhibitor; it blocks the enzyme that breaks down incretin
hormones like GLP-1. This prolongs the action of GLP-1, stimulating glucose-dependent insulin release
and suppressing glucagon.
A – This describes the mechanism of sulfonylureas (e.g., glipizide, glyburide).
C – This describes the mechanism of biguanides (metformin).
D – This describes the mechanism of SGLT2 inhibitors (e.g., empagliflozin, canagliflozin).
Q2: A patient with Addison's disease is admitted with hypotension, hyponatremia, hyperkalemia, and
hypoglycemia. Which medication should the nurse prepare to administer FIRST?
A. Fludrocortisone
B. Hydrocortisone IV [CORRECT]
C. Spironolactone
D. 10% dextrose IV
,Correct Answer: B
Rationale: [CORRECT] This patient is in acute adrenal crisis (Addisonian crisis). The priority is IV
glucocorticoid (hydrocortisone) replacement to restore vascular tone, blood pressure, and correct
metabolic imbalances. High-dose hydrocortisone has sufficient mineralocorticoid activity to correct
hyperkalemia and hyponatremia initially.
A – Fludrocortisone is a mineralocorticoid used for chronic maintenance; it lacks the glucocorticoid
potency needed for acute shock.
C – Spironolactone is a potassium-sparing diuretic; it is contraindicated as the patient is already
hyperkalemic.
D – While dextrose treats hypoglycemia, the primary driver of shock is cortisol deficiency;
hydrocortisone addresses both the hypotension and the hypoglycemia.
Q3: A patient is prescribed levothyroxine (Synthroid) for hypothyroidism. Which instruction is most
critical for the nurse to include in the discharge teaching?
A. "Take the medication with breakfast to ensure absorption."
B. "Take the medication on an empty stomach, 30–60 minutes before breakfast." [CORRECT]
C. "Avoid foods high in iodine, such as seafood."
D. "Stop the medication immediately if you experience palpitations."
Correct Answer: B
Rationale: [CORRECT] Levothyroxine absorption is decreased by food, calcium, and iron. It must be taken
on an empty stomach consistently to maintain stable thyroid levels.
A – Food decreases absorption; taking it with breakfast reduces efficacy.
C – Iodine is not restricted in hypothyroid patients taking levothyroxine.
D – Palpitations may indicate toxicity, but the patient should contact the provider for dose adjustment
rather than stopping abruptly.
Q4: The nurse is caring for a patient with diabetic ketoacidosis (DKA). The patient's initial lab results
include: pH 7.20, PaCO2 28 mmHg, HCO3 12 mEq/L, and serum potassium 5.8 mEq/L. As insulin therapy
is initiated, what is the nurse's priority intervention regarding potassium?
A. Hold insulin if potassium is >5.0 mEq/L.
, B. Monitor for signs of hypokalemia and anticipate IV potassium replacement. [CORRECT]
C. Administer IV potassium immediately before insulin.
D. Administer a potassium-sparing diuretic.
Correct Answer: B
Rationale: [CORRECT] Although the initial potassium is high due to acidosis (H+-K+ shift) and renal
failure, insulin drives potassium back into cells, causing a rapid drop. As acidosis corrects and fluids
dilute the potassium, severe hypokalemia is a major risk.
A – Insulin is the treatment for DKA; it should not be held, but potassium must be monitored closely.
C – Giving potassium when the serum level is 5.8 mEq/L would be dangerous (hyperkalemia risk).
D – Potassium-sparing diuretics are contraindicated in renal failure and hyperkalemia.
Q5: A patient with Cushing's syndrome is admitted for an adrenalectomy. Which preoperative
assessment finding is most concerning to the nurse?
A. Moon face and buffalo hump.
B. Serum glucose of 180 mg/dL.
C. Serum potassium of 3.0 mEq/L. [CORRECT]
D. Blood pressure of 150/90 mm Hg.
Correct Answer: C
Rationale: [CORRECT] Cushing's syndrome involves excess cortisol (glucocorticoid) and often
aldosterone (mineralocorticoid). This leads to sodium retention and potassium excretion (hypokalemia).
Hypokalemia increases the risk of cardiac dysrhythmias, especially during surgery.
A, B, D – These are expected findings in Cushing's syndrome due to hypercortisolism; while they require
management, hypokalemia poses the most immediate physiological threat.
Q6: A patient is starting metformin. Which condition is a contraindication for this medication?
A. Hypertension
B. Renal impairment (eGFR <30 mL/min) [CORRECT]
C. Hyperlipidemia
