NU 216 Exam 3 | Adult Health I (2026) Q&A | Herzing University
1. Which hemoglobin A1c value meets the American Diabetes Association diagnostic criterion
for diabetes mellitus?
A) 5.4%
B) 5.9%
C) 6.1%
D) 6.5%
Correct Answer: 6.5%
Rationale: An A1c of 6.5% or higher confirms the diagnosis of diabetes mellitus, while values of
5.7–6.4% indicate prediabetes and values below 5.7% are normal. The other options fall below
the diagnostic threshold. A1c reflects average glucose over the preceding two to three months.
2. Which action should the nurse take first when a patient with DKA has a serum potassium of
3.0 mEq/L and an order for an IV regular insulin infusion?
A) Start the IV regular insulin infusion as prescribed
B) Hold the insulin and notify the provider of the potassium level
C) Push the prescribed potassium chloride rapidly by IV
D) Administer the insulin and recheck the potassium in 6 hours
Correct Answer: Hold the insulin and notify the provider of the potassium level
Rationale: Insulin drives potassium intracellularly and can precipitate fatal hypokalemia when
potassium is below 3.3 mEq/L, so insulin is held until potassium is corrected. Rapid IV potassium
push is contraindicated because it can cause fatal cardiac dysrhythmias. Starting insulin without
correcting potassium is dangerous.
,3. Which intervention is the priority for a patient admitted with hyperosmolar hyperglycemic
state (HHS) who has a blood glucose of 980 mg/dL, serum osmolality of 340 mOsm/kg, negative
ketones, and a blood pressure of 88/54 mm Hg?
A) Begin an IV bolus of 0.9% sodium chloride
B) Administer subcutaneous NPH insulin
C) Infuse 5% dextrose in water
D) Insert an indwelling urinary catheter to monitor output
Correct Answer: Begin an IV bolus of 0.9% sodium chloride
Rationale: Profound dehydration drives morbidity in HHS, so isotonic fluid resuscitation is the
first priority before low-dose insulin therapy is initiated. D5W is reserved until glucose
approaches 250–300 mg/dL, and catheterization does not address the circulatory volume
deficit. Fluid resuscitation precedes insulin in HHS.
4. Which statement indicates correct understanding of levothyroxine teaching?
A) “I will take it with my calcium supplement at breakfast.”
B) “I will take it with a full meal in the evening.”
C) “I will take it on an empty stomach 30 to 60 minutes before breakfast.”
D) “I will stop taking it once my energy returns.”
Correct Answer: “I will take it on an empty stomach 30 to 60 minutes before breakfast.”
Rationale: Levothyroxine is best absorbed on an empty stomach, while calcium, iron, and food
markedly reduce absorption. Therapy is lifelong, so stopping when symptoms improve causes
recurrence of hypothyroidism. Consistent timing and separation from interfering substances are
essential.
,5. Which medication does the nurse anticipate for a patient who develops a positive Trousseau
sign and perioral tingling 6 hours after a thyroidectomy?
A) IV levothyroxine
B) IV calcium gluconate
C) IV potassium chloride
D) IV magnesium sulfate
Correct Answer: IV calcium gluconate
Rationale: A positive Trousseau sign with perioral tingling indicates hypocalcemia from
inadvertent parathyroid trauma or removal, an emergency treated with IV calcium gluconate.
Levothyroxine replaces thyroid hormone and will not correct the calcium level. Prompt calcium
replacement prevents tetany and seizures.
6. Which instruction is most appropriate when a patient with Addison’s disease on daily oral
hydrocortisone calls reporting influenza with persistent vomiting and inability to keep
medications down?
A) “Skip your hydrocortisone until the vomiting stops.”
B) “Resume your usual dose when you feel better in a few days.”
C) “Take an extra dose of fludrocortisone and rest at home.”
D) “Contact the provider immediately; you may need injectable steroids.”
Correct Answer: “Contact the provider immediately; you may need injectable steroids.”
Rationale: Vomiting prevents absorption of oral glucocorticoids and places the patient at high
risk for Addisonian crisis, requiring immediate evaluation and possible parenteral
hydrocortisone. Skipping or delaying doses invites life-threatening cardiovascular collapse.
Stress dosing is essential during acute illness.
, 7. Which nursing intervention is the priority for a newly admitted patient with Cushing’s
syndrome who has a moon face, truncal obesity, a blood glucose of 214 mg/dL, and a blood
pressure of 168/96 mm Hg?
A) Monitor blood glucose closely and implement fall precautions
B) Provide a high-protein, low-potassium diet
C) Encourage vigorous aerobic exercise daily
D) Institute a fluid restriction of 500 mL/day
Correct Answer: Monitor blood glucose closely and implement fall precautions
Rationale: Hyperglycemia from gluconeogenesis requires close glucose monitoring, and muscle
wasting, skin fragility, and osteoporosis make fall prevention critical in Cushing’s syndrome.
Vigorous exercise increases fracture risk, and the other options do not address the highest-risk
complications. Safety and glucose control are paramount.
8. Which condition do polyuria with very dilute urine (specific gravity 1.002), hypernatremia,
and intense thirst after neurosurgery most likely represent?
A) SIADH
B) Fluid volume overload
C) Diabetes insipidus
D) Cerebral salt wasting
Correct Answer: Diabetes insipidus
Rationale: Polyuria with very dilute urine, hypernatremia, and intense thirst after neurosurgery
is classic for diabetes insipidus caused by decreased ADH and is treated with desmopressin.
SIADH and cerebral salt wasting cause hyponatremia, and furosemide would worsen the volume
deficit. Recognizing this pattern prevents delayed treatment.
1. Which hemoglobin A1c value meets the American Diabetes Association diagnostic criterion
for diabetes mellitus?
A) 5.4%
B) 5.9%
C) 6.1%
D) 6.5%
Correct Answer: 6.5%
Rationale: An A1c of 6.5% or higher confirms the diagnosis of diabetes mellitus, while values of
5.7–6.4% indicate prediabetes and values below 5.7% are normal. The other options fall below
the diagnostic threshold. A1c reflects average glucose over the preceding two to three months.
2. Which action should the nurse take first when a patient with DKA has a serum potassium of
3.0 mEq/L and an order for an IV regular insulin infusion?
A) Start the IV regular insulin infusion as prescribed
B) Hold the insulin and notify the provider of the potassium level
C) Push the prescribed potassium chloride rapidly by IV
D) Administer the insulin and recheck the potassium in 6 hours
Correct Answer: Hold the insulin and notify the provider of the potassium level
Rationale: Insulin drives potassium intracellularly and can precipitate fatal hypokalemia when
potassium is below 3.3 mEq/L, so insulin is held until potassium is corrected. Rapid IV potassium
push is contraindicated because it can cause fatal cardiac dysrhythmias. Starting insulin without
correcting potassium is dangerous.
,3. Which intervention is the priority for a patient admitted with hyperosmolar hyperglycemic
state (HHS) who has a blood glucose of 980 mg/dL, serum osmolality of 340 mOsm/kg, negative
ketones, and a blood pressure of 88/54 mm Hg?
A) Begin an IV bolus of 0.9% sodium chloride
B) Administer subcutaneous NPH insulin
C) Infuse 5% dextrose in water
D) Insert an indwelling urinary catheter to monitor output
Correct Answer: Begin an IV bolus of 0.9% sodium chloride
Rationale: Profound dehydration drives morbidity in HHS, so isotonic fluid resuscitation is the
first priority before low-dose insulin therapy is initiated. D5W is reserved until glucose
approaches 250–300 mg/dL, and catheterization does not address the circulatory volume
deficit. Fluid resuscitation precedes insulin in HHS.
4. Which statement indicates correct understanding of levothyroxine teaching?
A) “I will take it with my calcium supplement at breakfast.”
B) “I will take it with a full meal in the evening.”
C) “I will take it on an empty stomach 30 to 60 minutes before breakfast.”
D) “I will stop taking it once my energy returns.”
Correct Answer: “I will take it on an empty stomach 30 to 60 minutes before breakfast.”
Rationale: Levothyroxine is best absorbed on an empty stomach, while calcium, iron, and food
markedly reduce absorption. Therapy is lifelong, so stopping when symptoms improve causes
recurrence of hypothyroidism. Consistent timing and separation from interfering substances are
essential.
,5. Which medication does the nurse anticipate for a patient who develops a positive Trousseau
sign and perioral tingling 6 hours after a thyroidectomy?
A) IV levothyroxine
B) IV calcium gluconate
C) IV potassium chloride
D) IV magnesium sulfate
Correct Answer: IV calcium gluconate
Rationale: A positive Trousseau sign with perioral tingling indicates hypocalcemia from
inadvertent parathyroid trauma or removal, an emergency treated with IV calcium gluconate.
Levothyroxine replaces thyroid hormone and will not correct the calcium level. Prompt calcium
replacement prevents tetany and seizures.
6. Which instruction is most appropriate when a patient with Addison’s disease on daily oral
hydrocortisone calls reporting influenza with persistent vomiting and inability to keep
medications down?
A) “Skip your hydrocortisone until the vomiting stops.”
B) “Resume your usual dose when you feel better in a few days.”
C) “Take an extra dose of fludrocortisone and rest at home.”
D) “Contact the provider immediately; you may need injectable steroids.”
Correct Answer: “Contact the provider immediately; you may need injectable steroids.”
Rationale: Vomiting prevents absorption of oral glucocorticoids and places the patient at high
risk for Addisonian crisis, requiring immediate evaluation and possible parenteral
hydrocortisone. Skipping or delaying doses invites life-threatening cardiovascular collapse.
Stress dosing is essential during acute illness.
, 7. Which nursing intervention is the priority for a newly admitted patient with Cushing’s
syndrome who has a moon face, truncal obesity, a blood glucose of 214 mg/dL, and a blood
pressure of 168/96 mm Hg?
A) Monitor blood glucose closely and implement fall precautions
B) Provide a high-protein, low-potassium diet
C) Encourage vigorous aerobic exercise daily
D) Institute a fluid restriction of 500 mL/day
Correct Answer: Monitor blood glucose closely and implement fall precautions
Rationale: Hyperglycemia from gluconeogenesis requires close glucose monitoring, and muscle
wasting, skin fragility, and osteoporosis make fall prevention critical in Cushing’s syndrome.
Vigorous exercise increases fracture risk, and the other options do not address the highest-risk
complications. Safety and glucose control are paramount.
8. Which condition do polyuria with very dilute urine (specific gravity 1.002), hypernatremia,
and intense thirst after neurosurgery most likely represent?
A) SIADH
B) Fluid volume overload
C) Diabetes insipidus
D) Cerebral salt wasting
Correct Answer: Diabetes insipidus
Rationale: Polyuria with very dilute urine, hypernatremia, and intense thirst after neurosurgery
is classic for diabetes insipidus caused by decreased ADH and is treated with desmopressin.
SIADH and cerebral salt wasting cause hyponatremia, and furosemide would worsen the volume
deficit. Recognizing this pattern prevents delayed treatment.
