NSG 3280 EXAM 3 PRACTICE QUESTIONS AND ANSWERS
Pathophysiology for Nurses I – Neurologic, Sensory, &
Musculoskeletal Disorders
Question 1: A patient with type 1 diabetes mellitus has a blood glucose level of 450 mg/dL, serum
ketones positive, and arterial pH of 7.25. The nurse recognizes this as:
A) Hyperosmolar hyperglycemic state (HHS)
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemia
D) Lactic acidosis
Answer: B
Rationale: DKA is characterized by hyperglycemia (>250 mg/dL), ketosis, and metabolic acidosis (pH
<7.3). HHS presents with severe hyperglycemia (>600 mg/dL) with minimal ketones and no acidosis.
Hypoglycemia would present with low blood glucose and altered mental status. Lactic acidosis is not
typically associated with type 1 diabetes without another cause.
Question 2: Which of the following is a key pathophysiologic feature of type 1 diabetes mellitus?
A) Insulin resistance and obesity
B) Autoimmune destruction of pancreatic beta cells
C) Gestational onset
D) Maturity-onset diabetes of the young (MODY)
Answer: B
Rationale: Type 1 diabetes is an autoimmune disorder in which the body's immune system destroys the
insulin-producing beta cells of the pancreas, leading to absolute insulin deficiency. Type 2 diabetes is
characterized by insulin resistance and relative insulin deficiency. Gestational diabetes develops during
pregnancy, and MODY is a monogenic form.
,Question 3: A patient with type 2 diabetes has an elevated hemoglobin A1c of 9.5% (normal <5.7%). This
test measures:
A) Current blood glucose level
B) Average blood glucose over the past 2-3 months
C) Insulin production capacity
D) Presence of ketones
Answer: B
Rationale: Hemoglobin A1c (HbA1c) reflects average blood glucose over approximately 2-3 months,
corresponding to the lifespan of red blood cells. The American Diabetes Association recommends a goal
of <7% for most nonpregnant adults with diabetes.
Question 4: A patient is admitted with diabetic ketoacidosis (DKA). Which of the following serum
electrolyte abnormalities is most concerning?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B
Rationale: In DKA, total body potassium is depleted despite normal or elevated serum levels. As insulin
therapy is initiated, potassium shifts intracellularly, potentially causing life-threatening hypokalemia.
Potassium must be monitored closely and replaced as indicated.
,Question 5: A patient with hyperthyroidism has exophthalmos (protruding eyes). This is caused by:
A) Increased thyroid hormone directly affecting eye muscles
B) Autoimmune inflammation and edema of orbital tissues
C) Pituitary tumor
D) Corneal abrasion
Answer: B
Rationale: Graves ophthalmopathy (exophthalmos) is an autoimmune condition caused by inflammation
and deposition of glycosaminoglycans in orbital tissues, leading to proptosis, periorbital edema, and
diplopia. It occurs most commonly in Graves disease, an autoimmune form of hyperthyroidism
Question 6: A patient presents with weight loss, heat intolerance, tachycardia, and fine tremors. Which
of the following laboratory findings would the nurse expect?
A) Elevated TSH, low T4
B) Low TSH, elevated T3/T4
C) Normal TSH, low T3/T4
D) Elevated TSH, elevated T3/T4
Answer: B
Rationale: Primary hyperthyroidism presents with low TSH (due to negative feedback) and elevated free
T3 and T4 levels. Hashimoto thyroiditis (hypothyroidism) presents with elevated TSH and low T3/T4.
Question 7: A patient with hypothyroidism is at risk for which of the following life-threatening
complications if left untreated?
, A) Thyroid storm
B) Myxedema coma
C) Addisonian crisis
D) Pheochromocytoma
Answer: B
Rationale: Myxedema coma is a life-threatening complication of severe, untreated hypothyroidism
characterized by hypothermia, bradycardia, hypotension, and altered mental status. Thyroid storm is
the hyperthyroid emergency. Addisonian crisis is associated with adrenal insufficiency.
Question 8: A patient is diagnosed with Cushing syndrome. Which of the following physical findings
would the nurse expect?
A) Moon face, buffalo hump, purple striae, hyperglycemia
B) Weight loss, hyperpigmentation, hypotension
C) Exophthalmos, goiter, pretibial myxedema
D) Tetany, Chvostek sign, Trousseau sign
Answer: A
Rationale: Cushing syndrome results from chronic cortisol excess, causing central obesity (moon face,
buffalo hump), purple abdominal striae, hyperglycemia, hypertension, and easy bruising. Weight loss
and hyperpigmentation suggest Addison disease (adrenal insufficiency). Exophthalmos is seen in Graves
disease. Tetany suggests hypocalcemia.
Question 9: A patient with Addison disease (primary adrenal insufficiency) would most likely experience
which electrolyte imbalance?
Pathophysiology for Nurses I – Neurologic, Sensory, &
Musculoskeletal Disorders
Question 1: A patient with type 1 diabetes mellitus has a blood glucose level of 450 mg/dL, serum
ketones positive, and arterial pH of 7.25. The nurse recognizes this as:
A) Hyperosmolar hyperglycemic state (HHS)
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemia
D) Lactic acidosis
Answer: B
Rationale: DKA is characterized by hyperglycemia (>250 mg/dL), ketosis, and metabolic acidosis (pH
<7.3). HHS presents with severe hyperglycemia (>600 mg/dL) with minimal ketones and no acidosis.
Hypoglycemia would present with low blood glucose and altered mental status. Lactic acidosis is not
typically associated with type 1 diabetes without another cause.
Question 2: Which of the following is a key pathophysiologic feature of type 1 diabetes mellitus?
A) Insulin resistance and obesity
B) Autoimmune destruction of pancreatic beta cells
C) Gestational onset
D) Maturity-onset diabetes of the young (MODY)
Answer: B
Rationale: Type 1 diabetes is an autoimmune disorder in which the body's immune system destroys the
insulin-producing beta cells of the pancreas, leading to absolute insulin deficiency. Type 2 diabetes is
characterized by insulin resistance and relative insulin deficiency. Gestational diabetes develops during
pregnancy, and MODY is a monogenic form.
,Question 3: A patient with type 2 diabetes has an elevated hemoglobin A1c of 9.5% (normal <5.7%). This
test measures:
A) Current blood glucose level
B) Average blood glucose over the past 2-3 months
C) Insulin production capacity
D) Presence of ketones
Answer: B
Rationale: Hemoglobin A1c (HbA1c) reflects average blood glucose over approximately 2-3 months,
corresponding to the lifespan of red blood cells. The American Diabetes Association recommends a goal
of <7% for most nonpregnant adults with diabetes.
Question 4: A patient is admitted with diabetic ketoacidosis (DKA). Which of the following serum
electrolyte abnormalities is most concerning?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B
Rationale: In DKA, total body potassium is depleted despite normal or elevated serum levels. As insulin
therapy is initiated, potassium shifts intracellularly, potentially causing life-threatening hypokalemia.
Potassium must be monitored closely and replaced as indicated.
,Question 5: A patient with hyperthyroidism has exophthalmos (protruding eyes). This is caused by:
A) Increased thyroid hormone directly affecting eye muscles
B) Autoimmune inflammation and edema of orbital tissues
C) Pituitary tumor
D) Corneal abrasion
Answer: B
Rationale: Graves ophthalmopathy (exophthalmos) is an autoimmune condition caused by inflammation
and deposition of glycosaminoglycans in orbital tissues, leading to proptosis, periorbital edema, and
diplopia. It occurs most commonly in Graves disease, an autoimmune form of hyperthyroidism
Question 6: A patient presents with weight loss, heat intolerance, tachycardia, and fine tremors. Which
of the following laboratory findings would the nurse expect?
A) Elevated TSH, low T4
B) Low TSH, elevated T3/T4
C) Normal TSH, low T3/T4
D) Elevated TSH, elevated T3/T4
Answer: B
Rationale: Primary hyperthyroidism presents with low TSH (due to negative feedback) and elevated free
T3 and T4 levels. Hashimoto thyroiditis (hypothyroidism) presents with elevated TSH and low T3/T4.
Question 7: A patient with hypothyroidism is at risk for which of the following life-threatening
complications if left untreated?
, A) Thyroid storm
B) Myxedema coma
C) Addisonian crisis
D) Pheochromocytoma
Answer: B
Rationale: Myxedema coma is a life-threatening complication of severe, untreated hypothyroidism
characterized by hypothermia, bradycardia, hypotension, and altered mental status. Thyroid storm is
the hyperthyroid emergency. Addisonian crisis is associated with adrenal insufficiency.
Question 8: A patient is diagnosed with Cushing syndrome. Which of the following physical findings
would the nurse expect?
A) Moon face, buffalo hump, purple striae, hyperglycemia
B) Weight loss, hyperpigmentation, hypotension
C) Exophthalmos, goiter, pretibial myxedema
D) Tetany, Chvostek sign, Trousseau sign
Answer: A
Rationale: Cushing syndrome results from chronic cortisol excess, causing central obesity (moon face,
buffalo hump), purple abdominal striae, hyperglycemia, hypertension, and easy bruising. Weight loss
and hyperpigmentation suggest Addison disease (adrenal insufficiency). Exophthalmos is seen in Graves
disease. Tetany suggests hypocalcemia.
Question 9: A patient with Addison disease (primary adrenal insufficiency) would most likely experience
which electrolyte imbalance?
