NSG 4100 Exam 3 Review | Galen College of Nursing
NSG 4100 Adult Health III
Exam 3 — Comprehensive Review
Questions & Verified Solutions | Grade A | 2026/2027 Update
Galen College of Nursing
RN Licensure & BSN Academic Course Focus
Academic Year 2026–2027
1
, NSG 4100 Exam 3 Review | Galen College of Nursing
Abstract
This comprehensive examination review document for the Galen College of Nursing NSG
4100 Adult Health III Exam 3 encompasses 50 evidence-based questions with verified correct
answers and detailed clinical rationales across six advanced critical care domains: (I) Complex
Endocrine Disorders, addressing diabetic ketoacidosis, hyperosmolar hyperglycemic state, thyroid
storm, myxedema coma, adrenal crisis, pheochromocytoma crisis, syndrome of inappropriate
antidiuretic hormone, and diabetes insipidus; (II) Complex Hematologic Disorders, covering
disseminated intravascular coagulation, heparin-induced thrombocytopenia, thrombotic
thrombocytopenic purpura, hemolytic uremic syndrome, sickle cell crisis, and acute leukemia
complications; (III) Complex Immunologic and Autoimmune Disorders, including systemic lupus
erythematosus flares, severe rheumatoid arthritis, Goodpasture syndrome, Guillain-Barré
syndrome, myasthenia gravis crisis, and multiple sclerosis relapse management; (IV) Complex
Infectious Disease Emergencies, encompassing sepsis and septic shock, meningitis, infective
endocarditis, necrotizing fasciitis, toxic shock syndrome, and severe COVID-19 respiratory failure;
(V) Complex Renal and Electrolyte Emergencies, featuring hyperkalemia emergency management,
severe symptomatic hyponatremia, hypercalcemia of malignancy, acute kidney injury, and
contrast-induced nephropathy prevention; and (VI) Advanced Critical Care Pharmacology Review,
covering vasopressors, inotropes, sedation protocols, analgesics, neuromuscular blockers, and
medication titration protocols. All content is aligned with current evidence-based guidelines from
the ADA, ATA, Surviving Sepsis Campaign, KDIGO, IDSA, and ASH.
Keywords: critical care nursing, NSG 4100, Adult Health III, diabetic ketoacidosis, thyroid storm,
adrenal crisis, DIC, heparin-induced thrombocytopenia, sepsis, septic shock, hyperkalemia,
hyponatremia, vasopressors, sedation protocols
2
, NSG 4100 Exam 3 Review | Galen College of Nursing
Introduction
The NSG 4100 Adult Health III course at Galen College of Nursing represents an advanced
critical care nursing experience in the BSN curriculum, preparing registered nurses for complex
clinical judgment in the management of critically ill adult patients. This Exam 3 review document
addresses six core domains of advanced practice, each requiring integration of pathophysiological
understanding, pharmacological knowledge, and evidence-based clinical decision-making. The 50
questions presented herein assess the student’s ability to prioritize nursing interventions, interpret
complex clinical scenarios, and apply current evidence-based guidelines from authoritative bodies
including the American Diabetes Association (ADA), the American Thyroid Association (ATA), the
Surviving Sepsis Campaign, the Kidney Disease: Improving Global Outcomes (KDIGO)
organization, the Infectious Diseases Society of America (IDSA), and the American Society of
Hematology (ASH). Each question is accompanied by a detailed rationale that identifies the correct
answer and explains why alternative options are incorrect, reinforcing the clinical reasoning
process essential for safe critical care nursing practice. The examination format includes 50
questions comprising multiple-choice and alternate-format items (select-all-that-apply, ordered
response). Answers are presented in bold green text with rationales citing current evidence-based
critical care guidelines. This review is aligned with the 2026/2027 academic cycle and reflects the
most current guideline updates.
Domain I: Complex Endocrine Disorders
1. A patient with DKA has a blood glucose of 620 mg/dL, pH 7.12, and serum potassium of 5.2
mEq/L. After initiating IV fluid resuscitation, what is the next priority intervention?
A) Administer sodium bicarbonate 100 mEq IV
B) Begin continuous IV insulin infusion at 0.1 units/kg/hr
C) Administer subcutaneous insulin glargine
D) Restrict potassium intake
Correct Answer: B
Rationale: After initial fluid resuscitation, continuous IV insulin infusion (0.1 units/kg/hr) is
the cornerstone of DKA management to suppress ketogenesis and clear ketoacids (ADA
2009/2014 Guidelines). Bicarbonate is controversial and reserved for pH below 6.9.
Subcutaneous insulin is contraindicated in DKA due to impaired perfusion and unreliable
absorption. Potassium of 5.2 mEq/L will likely drop with insulin therapy, requiring close
monitoring and replacement once levels fall below 5.3 mEq/L, but is not the immediate next
priority over insulin initiation.
2. A patient with DKA has a serum potassium of 3.8 mEq/L after 2 hours of insulin infusion and IV
fluids. What is the appropriate potassium management?
A) No potassium replacement needed; continue current therapy
B) Add 20-40 mEq/L potassium to IV fluids to maintain serum K+ 4.0-5.0 mEq/L
C) Administer potassium chloride 40 mEq IV push
D) Hold insulin until potassium is above 4.5 mEq/L
Correct Answer: B
Rationale: Per ADA guidelines, potassium should be added to IV fluids when serum K+ falls
below 5.3 mEq/L (or below upper limit of normal). The target is to maintain K+ at 4.0-5.0
mEq/L during DKA treatment. Insulin shifts potassium intracellularly, and total body
potassium is already depleted despite initial normal or elevated levels. IV push potassium is
dangerous and contraindicated. Holding insulin would worsen ketoacidosis.
3. A patient with HHS presents with a blood glucose of 980 mg/dL, serum osmolality of 380
mOsm/kg, and altered mental status. What distinguishes HHS from DKA in terms of initial
management?
A) HHS requires less aggressive fluid resuscitation
B) HHS requires more aggressive fluid resuscitation due to profound dehydration (average
9L deficit)
C) HHS requires higher insulin doses than DKA
3
NSG 4100 Adult Health III
Exam 3 — Comprehensive Review
Questions & Verified Solutions | Grade A | 2026/2027 Update
Galen College of Nursing
RN Licensure & BSN Academic Course Focus
Academic Year 2026–2027
1
, NSG 4100 Exam 3 Review | Galen College of Nursing
Abstract
This comprehensive examination review document for the Galen College of Nursing NSG
4100 Adult Health III Exam 3 encompasses 50 evidence-based questions with verified correct
answers and detailed clinical rationales across six advanced critical care domains: (I) Complex
Endocrine Disorders, addressing diabetic ketoacidosis, hyperosmolar hyperglycemic state, thyroid
storm, myxedema coma, adrenal crisis, pheochromocytoma crisis, syndrome of inappropriate
antidiuretic hormone, and diabetes insipidus; (II) Complex Hematologic Disorders, covering
disseminated intravascular coagulation, heparin-induced thrombocytopenia, thrombotic
thrombocytopenic purpura, hemolytic uremic syndrome, sickle cell crisis, and acute leukemia
complications; (III) Complex Immunologic and Autoimmune Disorders, including systemic lupus
erythematosus flares, severe rheumatoid arthritis, Goodpasture syndrome, Guillain-Barré
syndrome, myasthenia gravis crisis, and multiple sclerosis relapse management; (IV) Complex
Infectious Disease Emergencies, encompassing sepsis and septic shock, meningitis, infective
endocarditis, necrotizing fasciitis, toxic shock syndrome, and severe COVID-19 respiratory failure;
(V) Complex Renal and Electrolyte Emergencies, featuring hyperkalemia emergency management,
severe symptomatic hyponatremia, hypercalcemia of malignancy, acute kidney injury, and
contrast-induced nephropathy prevention; and (VI) Advanced Critical Care Pharmacology Review,
covering vasopressors, inotropes, sedation protocols, analgesics, neuromuscular blockers, and
medication titration protocols. All content is aligned with current evidence-based guidelines from
the ADA, ATA, Surviving Sepsis Campaign, KDIGO, IDSA, and ASH.
Keywords: critical care nursing, NSG 4100, Adult Health III, diabetic ketoacidosis, thyroid storm,
adrenal crisis, DIC, heparin-induced thrombocytopenia, sepsis, septic shock, hyperkalemia,
hyponatremia, vasopressors, sedation protocols
2
, NSG 4100 Exam 3 Review | Galen College of Nursing
Introduction
The NSG 4100 Adult Health III course at Galen College of Nursing represents an advanced
critical care nursing experience in the BSN curriculum, preparing registered nurses for complex
clinical judgment in the management of critically ill adult patients. This Exam 3 review document
addresses six core domains of advanced practice, each requiring integration of pathophysiological
understanding, pharmacological knowledge, and evidence-based clinical decision-making. The 50
questions presented herein assess the student’s ability to prioritize nursing interventions, interpret
complex clinical scenarios, and apply current evidence-based guidelines from authoritative bodies
including the American Diabetes Association (ADA), the American Thyroid Association (ATA), the
Surviving Sepsis Campaign, the Kidney Disease: Improving Global Outcomes (KDIGO)
organization, the Infectious Diseases Society of America (IDSA), and the American Society of
Hematology (ASH). Each question is accompanied by a detailed rationale that identifies the correct
answer and explains why alternative options are incorrect, reinforcing the clinical reasoning
process essential for safe critical care nursing practice. The examination format includes 50
questions comprising multiple-choice and alternate-format items (select-all-that-apply, ordered
response). Answers are presented in bold green text with rationales citing current evidence-based
critical care guidelines. This review is aligned with the 2026/2027 academic cycle and reflects the
most current guideline updates.
Domain I: Complex Endocrine Disorders
1. A patient with DKA has a blood glucose of 620 mg/dL, pH 7.12, and serum potassium of 5.2
mEq/L. After initiating IV fluid resuscitation, what is the next priority intervention?
A) Administer sodium bicarbonate 100 mEq IV
B) Begin continuous IV insulin infusion at 0.1 units/kg/hr
C) Administer subcutaneous insulin glargine
D) Restrict potassium intake
Correct Answer: B
Rationale: After initial fluid resuscitation, continuous IV insulin infusion (0.1 units/kg/hr) is
the cornerstone of DKA management to suppress ketogenesis and clear ketoacids (ADA
2009/2014 Guidelines). Bicarbonate is controversial and reserved for pH below 6.9.
Subcutaneous insulin is contraindicated in DKA due to impaired perfusion and unreliable
absorption. Potassium of 5.2 mEq/L will likely drop with insulin therapy, requiring close
monitoring and replacement once levels fall below 5.3 mEq/L, but is not the immediate next
priority over insulin initiation.
2. A patient with DKA has a serum potassium of 3.8 mEq/L after 2 hours of insulin infusion and IV
fluids. What is the appropriate potassium management?
A) No potassium replacement needed; continue current therapy
B) Add 20-40 mEq/L potassium to IV fluids to maintain serum K+ 4.0-5.0 mEq/L
C) Administer potassium chloride 40 mEq IV push
D) Hold insulin until potassium is above 4.5 mEq/L
Correct Answer: B
Rationale: Per ADA guidelines, potassium should be added to IV fluids when serum K+ falls
below 5.3 mEq/L (or below upper limit of normal). The target is to maintain K+ at 4.0-5.0
mEq/L during DKA treatment. Insulin shifts potassium intracellularly, and total body
potassium is already depleted despite initial normal or elevated levels. IV push potassium is
dangerous and contraindicated. Holding insulin would worsen ketoacidosis.
3. A patient with HHS presents with a blood glucose of 980 mg/dL, serum osmolality of 380
mOsm/kg, and altered mental status. What distinguishes HHS from DKA in terms of initial
management?
A) HHS requires less aggressive fluid resuscitation
B) HHS requires more aggressive fluid resuscitation due to profound dehydration (average
9L deficit)
C) HHS requires higher insulin doses than DKA
3
