GALEN COLLEGE OF NURSING – NUR
170 CONCEPTS OF MEDICAL-SURGICAL
NURSING EXAM 3 – QUESTIONS AND
ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: UNIT 5 — METABOLISM: DIABETES MELLITUS
Questions 1–34
1. Which physiologic problem is central to diabetes mellitus?
A) Excessive insulin sensitivity
B) Inability to absorb dietary protein
C) Impaired insulin production, insulin action, or both
D) Excessive red blood cell production
Correct Answer: Impaired insulin production, insulin action, or both
Rationale: Diabetes mellitus results from inadequate insulin secretion, impaired insulin action,
or a combination of both. Insulin normally facilitates glucose movement into cells and helps
regulate blood glucose. When insulin is deficient or ineffective, glucose remains in the
bloodstream, producing hyperglycemia and eventually contributing to vascular and neurologic
complications.
2. Which assessment finding is most characteristic of hyperglycemia?
A) Polyuria
B) Bradycardia
C) Hypothermia
D) Decreased thirst
Correct Answer: Polyuria
Rationale: Hyperglycemia increases the filtered glucose load in the kidneys. Glucose draws
water into the urine, producing osmotic diuresis and increased urination. Polyuria is therefore
commonly accompanied by polydipsia and dehydration. Persistent hyperglycemia may also
cause fatigue, blurred vision, recurrent infections, and delayed wound healing.
3. A client with type 1 diabetes develops deep, rapid respirations and fruity-smelling
breath. Which complication should the nurse suspect?
A) Hypoglycemia
B) Diabetic ketoacidosis
C) Hyperthyroidism
D) Peripheral venous disease
,Correct Answer: Diabetic ketoacidosis
Rationale: Diabetic ketoacidosis occurs primarily when there is severe insulin deficiency,
causing fat breakdown and ketone production. Metabolic acidosis can produce deep, rapid
Kussmaul respirations, while acetone contributes to fruity-smelling breath. DKA is a medical
emergency requiring fluid replacement, insulin therapy, electrolyte monitoring, and treatment of
the precipitating cause.
4. Which laboratory pattern is most consistent with diabetic ketoacidosis?
A) Normal glucose with respiratory alkalosis
B) Low glucose with metabolic alkalosis
C) Hyperglycemia with ketones and metabolic acidosis
D) Hypercalcemia without glucose abnormalities
Correct Answer: Hyperglycemia with ketones and metabolic acidosis
Rationale: DKA is characterized by insulin deficiency, hyperglycemia, ketone production, and
metabolic acidosis. Serum and urine ketones reflect increased fat metabolism, while bicarbonate
decreases as acidosis develops. Potassium requires close monitoring because total body
potassium may be depleted even when the initial serum value appears normal or elevated.
5. Which finding is more characteristic of hypoglycemia than hyperglycemia?
A) Polyuria
B) Dry mucous membranes
C) Trembling and diaphoresis
D) Fruity breath
Correct Answer: Trembling and diaphoresis
Rationale: Hypoglycemia activates the sympathetic nervous system, producing sweating,
tremors, palpitations, hunger, and anxiety. As glucose falls further, neuroglycopenic
manifestations such as confusion, seizures, or unconsciousness may occur. Rapid recognition
and treatment are essential because prolonged severe hypoglycemia can cause neurologic
injury.
6. A conscious client with diabetes is shaky, diaphoretic, and able to swallow. What should
the nurse do first?
A) Administer a rapid-acting carbohydrate
B) Give long-acting insulin
C) Encourage exercise
D) Restrict oral intake
Correct Answer: Administer a rapid-acting carbohydrate
Rationale: A conscious client with symptomatic hypoglycemia who can safely swallow should
receive a rapidly absorbed carbohydrate. Blood glucose should then be reassessed according to
, protocol, with additional treatment if necessary. Delaying treatment can allow neuroglycopenia
to progress to seizures or loss of consciousness.
7. An unconscious client with suspected severe hypoglycemia has no IV access. Which
medication should the nurse anticipate?
A) Metformin
B) Glucagon
C) Regular insulin
D) Furosemide
Correct Answer: Glucagon
Rationale: Glucagon raises blood glucose by stimulating hepatic glycogen breakdown and
glucose release. It can be administered when severe hypoglycemia occurs and IV access is
unavailable. The patient's airway and breathing remain priorities, and glucose should be
reassessed after treatment with appropriate follow-up nutrition once consciousness and
swallowing ability return.
8. Which statement best distinguishes type 1 diabetes from type 2 diabetes?
A) Type 1 diabetes never causes complications
B) Type 2 diabetes always requires insulin immediately
C) Type 1 diabetes involves significant insulin deficiency
D) Type 1 diabetes is caused exclusively by obesity
Correct Answer: Type 1 diabetes involves significant insulin deficiency
Rationale: Type 1 diabetes results from destruction or loss of pancreatic beta-cell function and
therefore produces significant insulin deficiency. People with type 1 diabetes require insulin
replacement for survival. Type 2 diabetes is characterized primarily by insulin resistance with
progressive beta-cell dysfunction and may initially be managed with lifestyle measures and
noninsulin medications.
9. Which teaching point is most important for a client with diabetic peripheral
neuropathy?
A) Walk barefoot indoors
B) Inspect the feet daily
C) Apply heating pads directly to the feet
D) Cut corns with a razor
Correct Answer: Inspect the feet daily
Rationale: Peripheral neuropathy reduces protective sensation and increases the risk of
unnoticed injury. Daily foot inspection helps identify blisters, cuts, redness, pressure areas, and
infection early. Clients should avoid barefoot walking and extreme temperatures and should use
appropriate footwear to reduce trauma and prevent diabetic foot complications.
170 CONCEPTS OF MEDICAL-SURGICAL
NURSING EXAM 3 – QUESTIONS AND
ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: UNIT 5 — METABOLISM: DIABETES MELLITUS
Questions 1–34
1. Which physiologic problem is central to diabetes mellitus?
A) Excessive insulin sensitivity
B) Inability to absorb dietary protein
C) Impaired insulin production, insulin action, or both
D) Excessive red blood cell production
Correct Answer: Impaired insulin production, insulin action, or both
Rationale: Diabetes mellitus results from inadequate insulin secretion, impaired insulin action,
or a combination of both. Insulin normally facilitates glucose movement into cells and helps
regulate blood glucose. When insulin is deficient or ineffective, glucose remains in the
bloodstream, producing hyperglycemia and eventually contributing to vascular and neurologic
complications.
2. Which assessment finding is most characteristic of hyperglycemia?
A) Polyuria
B) Bradycardia
C) Hypothermia
D) Decreased thirst
Correct Answer: Polyuria
Rationale: Hyperglycemia increases the filtered glucose load in the kidneys. Glucose draws
water into the urine, producing osmotic diuresis and increased urination. Polyuria is therefore
commonly accompanied by polydipsia and dehydration. Persistent hyperglycemia may also
cause fatigue, blurred vision, recurrent infections, and delayed wound healing.
3. A client with type 1 diabetes develops deep, rapid respirations and fruity-smelling
breath. Which complication should the nurse suspect?
A) Hypoglycemia
B) Diabetic ketoacidosis
C) Hyperthyroidism
D) Peripheral venous disease
,Correct Answer: Diabetic ketoacidosis
Rationale: Diabetic ketoacidosis occurs primarily when there is severe insulin deficiency,
causing fat breakdown and ketone production. Metabolic acidosis can produce deep, rapid
Kussmaul respirations, while acetone contributes to fruity-smelling breath. DKA is a medical
emergency requiring fluid replacement, insulin therapy, electrolyte monitoring, and treatment of
the precipitating cause.
4. Which laboratory pattern is most consistent with diabetic ketoacidosis?
A) Normal glucose with respiratory alkalosis
B) Low glucose with metabolic alkalosis
C) Hyperglycemia with ketones and metabolic acidosis
D) Hypercalcemia without glucose abnormalities
Correct Answer: Hyperglycemia with ketones and metabolic acidosis
Rationale: DKA is characterized by insulin deficiency, hyperglycemia, ketone production, and
metabolic acidosis. Serum and urine ketones reflect increased fat metabolism, while bicarbonate
decreases as acidosis develops. Potassium requires close monitoring because total body
potassium may be depleted even when the initial serum value appears normal or elevated.
5. Which finding is more characteristic of hypoglycemia than hyperglycemia?
A) Polyuria
B) Dry mucous membranes
C) Trembling and diaphoresis
D) Fruity breath
Correct Answer: Trembling and diaphoresis
Rationale: Hypoglycemia activates the sympathetic nervous system, producing sweating,
tremors, palpitations, hunger, and anxiety. As glucose falls further, neuroglycopenic
manifestations such as confusion, seizures, or unconsciousness may occur. Rapid recognition
and treatment are essential because prolonged severe hypoglycemia can cause neurologic
injury.
6. A conscious client with diabetes is shaky, diaphoretic, and able to swallow. What should
the nurse do first?
A) Administer a rapid-acting carbohydrate
B) Give long-acting insulin
C) Encourage exercise
D) Restrict oral intake
Correct Answer: Administer a rapid-acting carbohydrate
Rationale: A conscious client with symptomatic hypoglycemia who can safely swallow should
receive a rapidly absorbed carbohydrate. Blood glucose should then be reassessed according to
, protocol, with additional treatment if necessary. Delaying treatment can allow neuroglycopenia
to progress to seizures or loss of consciousness.
7. An unconscious client with suspected severe hypoglycemia has no IV access. Which
medication should the nurse anticipate?
A) Metformin
B) Glucagon
C) Regular insulin
D) Furosemide
Correct Answer: Glucagon
Rationale: Glucagon raises blood glucose by stimulating hepatic glycogen breakdown and
glucose release. It can be administered when severe hypoglycemia occurs and IV access is
unavailable. The patient's airway and breathing remain priorities, and glucose should be
reassessed after treatment with appropriate follow-up nutrition once consciousness and
swallowing ability return.
8. Which statement best distinguishes type 1 diabetes from type 2 diabetes?
A) Type 1 diabetes never causes complications
B) Type 2 diabetes always requires insulin immediately
C) Type 1 diabetes involves significant insulin deficiency
D) Type 1 diabetes is caused exclusively by obesity
Correct Answer: Type 1 diabetes involves significant insulin deficiency
Rationale: Type 1 diabetes results from destruction or loss of pancreatic beta-cell function and
therefore produces significant insulin deficiency. People with type 1 diabetes require insulin
replacement for survival. Type 2 diabetes is characterized primarily by insulin resistance with
progressive beta-cell dysfunction and may initially be managed with lifestyle measures and
noninsulin medications.
9. Which teaching point is most important for a client with diabetic peripheral
neuropathy?
A) Walk barefoot indoors
B) Inspect the feet daily
C) Apply heating pads directly to the feet
D) Cut corns with a razor
Correct Answer: Inspect the feet daily
Rationale: Peripheral neuropathy reduces protective sensation and increases the risk of
unnoticed injury. Daily foot inspection helps identify blisters, cuts, redness, pressure areas, and
infection early. Clients should avoid barefoot walking and extreme temperatures and should use
appropriate footwear to reduce trauma and prevent diabetic foot complications.
