NUR 257 Chronic Exam 3 Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section A: Endocrine Disorders & Diabetes Management
Q1: A 24-year-old patient is newly diagnosed with diabetes mellitus. Laboratory results
reveal positive GAD antibodies, undetectable C-peptide levels, and the patient reports a
15-pound weight loss over the past month despite increased appetite. The nurse
recognizes these findings are most consistent with which type of diabetes?
A. Type 2 diabetes mellitus
B. Type 1 diabetes mellitus [CORRECT]
C. Gestational diabetes mellitus
D. Prediabetes
Correct Answer: B
Rationale: Type 1 diabetes is an autoimmune disorder characterized by beta-cell
destruction, absolute insulin deficiency, positive GAD antibodies, undetectable C-peptide
(indicating no endogenous insulin production), and classic symptoms of polyphagia
with weight loss. Type 2 diabetes involves insulin resistance with relative insulin
deficiency and typically presents in older adults with obesity. Gestational diabetes
occurs during pregnancy. Prediabetes does not present with these severe metabolic
derangements.
,Q2: A patient with type 2 diabetes presents to the emergency department with blood
glucose of 520 mg/dL, pH 7.25, positive serum ketones, and Kussmaul respirations. The
nurse recognizes this as which acute complication?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis [CORRECT]
C. Hypoglycemic reaction
D. Thyroid storm
Correct Answer: B
Rationale: Diabetic ketoacidosis (DKA) is characterized by hyperglycemia (>250 mg/dL),
metabolic acidosis (pH <7.30), positive ketones, and Kussmaul respirations (deep, rapid
breathing to compensate for acidosis). HHNS presents with severe hyperglycemia
without ketosis or acidosis. Hypoglycemia presents with low blood glucose. Thyroid
storm is a hyperthyroid emergency with fever and tachycardia, not metabolic acidosis.
Q3: The nurse is caring for a patient with type 1 diabetes who reports shakiness,
diaphoresis, tachycardia, and confusion. The patient's blood glucose is 58 mg/dL.
Which intervention is the priority?
A. Administer subcutaneous insulin immediately
B. Give 15 grams of fast-acting carbohydrate [CORRECT]
C. Prepare for IV bicarbonate administration
D. Place the patient in a supine position
Correct Answer: B
, Rationale: Blood glucose <70 mg/dL indicates hypoglycemia. The priority intervention is
administering 15 grams of fast-acting carbohydrate (glucose tablets, juice, regular
soda) to raise blood glucose. Insulin would worsen hypoglycemia. Bicarbonate is for
metabolic acidosis (DKA). Supine position is not indicated; the patient should be
positioned safely to prevent aspiration if consciousness decreases.
Q4: A patient with type 2 diabetes is prescribed metformin. The nurse should include
which teaching point?
A. "Take this medication on an empty stomach for best absorption."
B. "This medication may cause lactic acidosis in patients with renal impairment."
[CORRECT]
C. "You should stop this medication if you develop a mild cold."
D. "This medication stimulates insulin secretion from the pancreas."
Correct Answer: B
Rationale: Metformin can cause lactic acidosis, a rare but serious complication,
particularly in patients with renal impairment, hepatic disease, or heart failure.
Metformin should be taken with food to reduce GI upset. It does not need to be stopped
for mild illness. Metformin reduces hepatic glucose production and increases insulin
sensitivity; it does not stimulate insulin secretion (that mechanism describes
sulfonylureas).
Q5: A patient with diabetes presents with blood glucose of 780 mg/dL, serum
osmolarity of 340 mOsm/L, severe dehydration, and altered mental status. Arterial
blood gas shows pH 7.38. The nurse recognizes this as which condition?
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section A: Endocrine Disorders & Diabetes Management
Q1: A 24-year-old patient is newly diagnosed with diabetes mellitus. Laboratory results
reveal positive GAD antibodies, undetectable C-peptide levels, and the patient reports a
15-pound weight loss over the past month despite increased appetite. The nurse
recognizes these findings are most consistent with which type of diabetes?
A. Type 2 diabetes mellitus
B. Type 1 diabetes mellitus [CORRECT]
C. Gestational diabetes mellitus
D. Prediabetes
Correct Answer: B
Rationale: Type 1 diabetes is an autoimmune disorder characterized by beta-cell
destruction, absolute insulin deficiency, positive GAD antibodies, undetectable C-peptide
(indicating no endogenous insulin production), and classic symptoms of polyphagia
with weight loss. Type 2 diabetes involves insulin resistance with relative insulin
deficiency and typically presents in older adults with obesity. Gestational diabetes
occurs during pregnancy. Prediabetes does not present with these severe metabolic
derangements.
,Q2: A patient with type 2 diabetes presents to the emergency department with blood
glucose of 520 mg/dL, pH 7.25, positive serum ketones, and Kussmaul respirations. The
nurse recognizes this as which acute complication?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis [CORRECT]
C. Hypoglycemic reaction
D. Thyroid storm
Correct Answer: B
Rationale: Diabetic ketoacidosis (DKA) is characterized by hyperglycemia (>250 mg/dL),
metabolic acidosis (pH <7.30), positive ketones, and Kussmaul respirations (deep, rapid
breathing to compensate for acidosis). HHNS presents with severe hyperglycemia
without ketosis or acidosis. Hypoglycemia presents with low blood glucose. Thyroid
storm is a hyperthyroid emergency with fever and tachycardia, not metabolic acidosis.
Q3: The nurse is caring for a patient with type 1 diabetes who reports shakiness,
diaphoresis, tachycardia, and confusion. The patient's blood glucose is 58 mg/dL.
Which intervention is the priority?
A. Administer subcutaneous insulin immediately
B. Give 15 grams of fast-acting carbohydrate [CORRECT]
C. Prepare for IV bicarbonate administration
D. Place the patient in a supine position
Correct Answer: B
, Rationale: Blood glucose <70 mg/dL indicates hypoglycemia. The priority intervention is
administering 15 grams of fast-acting carbohydrate (glucose tablets, juice, regular
soda) to raise blood glucose. Insulin would worsen hypoglycemia. Bicarbonate is for
metabolic acidosis (DKA). Supine position is not indicated; the patient should be
positioned safely to prevent aspiration if consciousness decreases.
Q4: A patient with type 2 diabetes is prescribed metformin. The nurse should include
which teaching point?
A. "Take this medication on an empty stomach for best absorption."
B. "This medication may cause lactic acidosis in patients with renal impairment."
[CORRECT]
C. "You should stop this medication if you develop a mild cold."
D. "This medication stimulates insulin secretion from the pancreas."
Correct Answer: B
Rationale: Metformin can cause lactic acidosis, a rare but serious complication,
particularly in patients with renal impairment, hepatic disease, or heart failure.
Metformin should be taken with food to reduce GI upset. It does not need to be stopped
for mild illness. Metformin reduces hepatic glucose production and increases insulin
sensitivity; it does not stimulate insulin secretion (that mechanism describes
sulfonylureas).
Q5: A patient with diabetes presents with blood glucose of 780 mg/dL, serum
osmolarity of 340 mOsm/L, severe dehydration, and altered mental status. Arterial
blood gas shows pH 7.38. The nurse recognizes this as which condition?
