NUR 265 Exam 2 | Two Updated Versions | Questions and
Answers | 2026 Update | 100% Correct Actual Exam
2026/2027 | Complete Exam-Style Questions with Detailed
Rationales | 100% Verified | Graded A+
Complex Endocrine and Metabolic Disorders
Q1: A patient is admitted to the ICU with a blood glucose of 650 mg/dL, positive serum
ketones, and an arterial pH of 7.25. Which initial nursing intervention is the highest priority?
A. Administer an IV push of regular insulin.
B. Initiate an infusion of 0.9% normal saline.
C. Add potassium chloride to the IV fluids.
D. Administer IV sodium bicarbonate.
Correct Answer: B
Rationale: The best answer is B. This choice is correct because aggressive fluid resuscitation
with isotonic saline is the first-line treatment to restore intravascular volume and improve
tissue perfusion in diabetic ketoacidosis, preceding insulin administration.
Q2: A patient with a history of Graves' disease presents to the emergency department with
a temperature of 104°F, heart rate of 145 bpm, and severe agitation. Which medication
should the nurse anticipate administering first to block the peripheral effects of thyroid
hormone?
A. Methimazole
B. Propranolol
C. Propylthiouracil (PTU)
D. Dexamethasone
Correct Answer: B
Rationale: This choice is correct because beta-blockers like propranolol are given
immediately in thyroid storm to rapidly control life-threatening tachycardia and block the
peripheral conversion of T4 to T3, while antithyroid medications take longer to act.
Q3: A patient with a known history of Addison's disease arrives at the clinic complaining of
severe nausea, vomiting, and profound weakness after a recent gastrointestinal illness. Vital
signs reveal a blood pressure of 82/50 mm Hg and a heart rate of 115 bpm. What is the
nurse's most critical action?
A. Administer an oral dose of fludrocortisone.
B. Prepare for immediate IV administration of hydrocortisone and isotonic fluids.
C. Obtain a stat serum cortisol level before any treatment.
D. Encourage the patient to drink oral rehydration solutions.
Correct Answer: B
,Rationale: The best answer is B. This aligns with the principle that an adrenal crisis is a life-
threatening emergency requiring immediate IV glucocorticoid replacement and aggressive
fluid resuscitation to reverse shock, without waiting for lab confirmation.
Q4: Which laboratory finding is most indicative of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
A. Serum sodium 152 mEq/L and urine specific gravity 1.002
B. Serum sodium 125 mEq/L and urine specific gravity 1.030
C. Serum potassium 2.8 mEq/L and urine output 4000 mL/day
D. Serum calcium 11.5 mg/dL and urine specific gravity 1.010
Correct Answer: B
Rationale: This choice is correct because SIADH causes water retention, leading to dilutional
hyponatremia and highly concentrated urine, reflected by a low serum sodium and high
urine specific gravity.
Q5: Review the following morning laboratory results for a patient admitted with altered
mental status:
- Glucose: 720 mg/dL
- Serum Osmolality: 330 mOsm/kg
- Arterial pH: 7.38
- Serum Ketones: Negative
Based on this data snippet, which condition is the patient most likely experiencing?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Adrenal Crisis
D. Lactic Acidosis
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the combination of extreme
hyperglycemia, high serum osmolality, normal pH, and absent ketones is the classic
diagnostic hallmark of HHS, distinguishing it from DKA.
Q6: A patient receiving a continuous IV insulin drip for DKA has a serum potassium level of
3.1 mEq/L. What is the nurse's priority action?
A. Continue the insulin drip and recheck potassium in one hour.
B. Hold the insulin drip and notify the provider to order potassium replacement.
C. Administer IV sodium polystyrene sulfonate.
D. Increase the rate of the insulin drip to clear the glucose faster.
Correct Answer: B
Rationale: This choice is correct because insulin drives potassium into the cells, and
administering it to a patient with pre-existing hypokalemia can cause fatal cardiac
dysrhythmias; potassium must be corrected first.
Q7: A patient is diagnosed with myxedema coma. Which clinical manifestation should the
nurse expect to find during the assessment?
A. Hyperthermia and tachycardia
B. Hypothermia and bradycardia
C. Diarrhea and hyperreflexia
, D. Hypertension and diaphoresis
Correct Answer: B
Rationale: The best answer is B. This matches the principle that myxedema coma is a state
of severe hypothyroidism, characterized by a generalized slowing of metabolic processes,
leading to low body temperature and a slow heart rate.
Q8: A patient with a pheochromocytoma is scheduled for surgical removal of the adrenal
tumor. Which preoperative medication classification is essential to prevent a hypertensive
crisis during surgery?
A. Beta-blockers alone
B. Alpha-adrenergic blockers
C. Loop diuretics
D. Corticosteroids
Correct Answer: B
Rationale: This choice is correct because alpha-blockers must be administered before beta-
blockers to prevent unopposed alpha-adrenergic stimulation, which could trigger a
catastrophic hypertensive crisis during tumor manipulation.
Q9: A patient with Cushing's syndrome is at high risk for which of the following
complications?
A. Hypoglycemia and hypotension
B. Pathologic bone fractures and skin tears
C. Hyperkalemia and metabolic alkalosis
D. Increased immune function and rapid wound healing
Correct Answer: B
Rationale: The best answer is B. This aligns with the pathophysiology of Cushing's, where
excess cortisol causes protein breakdown, leading to osteoporosis, muscle wasting, and
fragile, thin skin prone to injury.
Q10: When teaching a patient with Addison's disease about sick-day management, which
instruction is most important?
A. Decrease the dose of hydrocortisone during a fever.
B. Double or triple the oral glucocorticoid dose during illness or stress.
C. Stop taking fludrocortisone if nausea occurs.
D. Restrict sodium intake to prevent fluid retention.
Correct Answer: B
Rationale: This choice is correct because patients with adrenal insufficiency cannot mount a
natural cortisol response to stress, making it critical to increase their glucocorticoid dose
during illness to prevent an adrenal crisis.
Q11: A patient with hyperthyroidism is experiencing exophthalmos. Which nursing
intervention is most appropriate to protect the patient's eyes?
A. Apply warm, moist compresses to the eyes every hour.
B. Administer topical beta-blocker eye drops.
C. Elevate the head of the bed and apply artificial tears.
D. Patch the eyes closed tightly during sleep.
Correct Answer: C
Answers | 2026 Update | 100% Correct Actual Exam
2026/2027 | Complete Exam-Style Questions with Detailed
Rationales | 100% Verified | Graded A+
Complex Endocrine and Metabolic Disorders
Q1: A patient is admitted to the ICU with a blood glucose of 650 mg/dL, positive serum
ketones, and an arterial pH of 7.25. Which initial nursing intervention is the highest priority?
A. Administer an IV push of regular insulin.
B. Initiate an infusion of 0.9% normal saline.
C. Add potassium chloride to the IV fluids.
D. Administer IV sodium bicarbonate.
Correct Answer: B
Rationale: The best answer is B. This choice is correct because aggressive fluid resuscitation
with isotonic saline is the first-line treatment to restore intravascular volume and improve
tissue perfusion in diabetic ketoacidosis, preceding insulin administration.
Q2: A patient with a history of Graves' disease presents to the emergency department with
a temperature of 104°F, heart rate of 145 bpm, and severe agitation. Which medication
should the nurse anticipate administering first to block the peripheral effects of thyroid
hormone?
A. Methimazole
B. Propranolol
C. Propylthiouracil (PTU)
D. Dexamethasone
Correct Answer: B
Rationale: This choice is correct because beta-blockers like propranolol are given
immediately in thyroid storm to rapidly control life-threatening tachycardia and block the
peripheral conversion of T4 to T3, while antithyroid medications take longer to act.
Q3: A patient with a known history of Addison's disease arrives at the clinic complaining of
severe nausea, vomiting, and profound weakness after a recent gastrointestinal illness. Vital
signs reveal a blood pressure of 82/50 mm Hg and a heart rate of 115 bpm. What is the
nurse's most critical action?
A. Administer an oral dose of fludrocortisone.
B. Prepare for immediate IV administration of hydrocortisone and isotonic fluids.
C. Obtain a stat serum cortisol level before any treatment.
D. Encourage the patient to drink oral rehydration solutions.
Correct Answer: B
,Rationale: The best answer is B. This aligns with the principle that an adrenal crisis is a life-
threatening emergency requiring immediate IV glucocorticoid replacement and aggressive
fluid resuscitation to reverse shock, without waiting for lab confirmation.
Q4: Which laboratory finding is most indicative of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
A. Serum sodium 152 mEq/L and urine specific gravity 1.002
B. Serum sodium 125 mEq/L and urine specific gravity 1.030
C. Serum potassium 2.8 mEq/L and urine output 4000 mL/day
D. Serum calcium 11.5 mg/dL and urine specific gravity 1.010
Correct Answer: B
Rationale: This choice is correct because SIADH causes water retention, leading to dilutional
hyponatremia and highly concentrated urine, reflected by a low serum sodium and high
urine specific gravity.
Q5: Review the following morning laboratory results for a patient admitted with altered
mental status:
- Glucose: 720 mg/dL
- Serum Osmolality: 330 mOsm/kg
- Arterial pH: 7.38
- Serum Ketones: Negative
Based on this data snippet, which condition is the patient most likely experiencing?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Adrenal Crisis
D. Lactic Acidosis
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the combination of extreme
hyperglycemia, high serum osmolality, normal pH, and absent ketones is the classic
diagnostic hallmark of HHS, distinguishing it from DKA.
Q6: A patient receiving a continuous IV insulin drip for DKA has a serum potassium level of
3.1 mEq/L. What is the nurse's priority action?
A. Continue the insulin drip and recheck potassium in one hour.
B. Hold the insulin drip and notify the provider to order potassium replacement.
C. Administer IV sodium polystyrene sulfonate.
D. Increase the rate of the insulin drip to clear the glucose faster.
Correct Answer: B
Rationale: This choice is correct because insulin drives potassium into the cells, and
administering it to a patient with pre-existing hypokalemia can cause fatal cardiac
dysrhythmias; potassium must be corrected first.
Q7: A patient is diagnosed with myxedema coma. Which clinical manifestation should the
nurse expect to find during the assessment?
A. Hyperthermia and tachycardia
B. Hypothermia and bradycardia
C. Diarrhea and hyperreflexia
, D. Hypertension and diaphoresis
Correct Answer: B
Rationale: The best answer is B. This matches the principle that myxedema coma is a state
of severe hypothyroidism, characterized by a generalized slowing of metabolic processes,
leading to low body temperature and a slow heart rate.
Q8: A patient with a pheochromocytoma is scheduled for surgical removal of the adrenal
tumor. Which preoperative medication classification is essential to prevent a hypertensive
crisis during surgery?
A. Beta-blockers alone
B. Alpha-adrenergic blockers
C. Loop diuretics
D. Corticosteroids
Correct Answer: B
Rationale: This choice is correct because alpha-blockers must be administered before beta-
blockers to prevent unopposed alpha-adrenergic stimulation, which could trigger a
catastrophic hypertensive crisis during tumor manipulation.
Q9: A patient with Cushing's syndrome is at high risk for which of the following
complications?
A. Hypoglycemia and hypotension
B. Pathologic bone fractures and skin tears
C. Hyperkalemia and metabolic alkalosis
D. Increased immune function and rapid wound healing
Correct Answer: B
Rationale: The best answer is B. This aligns with the pathophysiology of Cushing's, where
excess cortisol causes protein breakdown, leading to osteoporosis, muscle wasting, and
fragile, thin skin prone to injury.
Q10: When teaching a patient with Addison's disease about sick-day management, which
instruction is most important?
A. Decrease the dose of hydrocortisone during a fever.
B. Double or triple the oral glucocorticoid dose during illness or stress.
C. Stop taking fludrocortisone if nausea occurs.
D. Restrict sodium intake to prevent fluid retention.
Correct Answer: B
Rationale: This choice is correct because patients with adrenal insufficiency cannot mount a
natural cortisol response to stress, making it critical to increase their glucocorticoid dose
during illness to prevent an adrenal crisis.
Q11: A patient with hyperthyroidism is experiencing exophthalmos. Which nursing
intervention is most appropriate to protect the patient's eyes?
A. Apply warm, moist compresses to the eyes every hour.
B. Administer topical beta-blocker eye drops.
C. Elevate the head of the bed and apply artificial tears.
D. Patch the eyes closed tightly during sleep.
Correct Answer: C
