NURSl 480/l NURS480l Examl 3l –l
Advancedl Medicall Surgicall Healthl
Nursing|l WCUl (Latestl 2026/l 2027l
Update)l Review|l 100%l Verifiedl Questionsl
&l Answersl |l Gradel A
Q:l Whatl isl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Lifel threatening,l profoundl hyperglycemial ofl 600l mg/dLl orl greater,l hyperosmolarityl
leadingl tol dehydrationl withl anl absencel ofl ketosis
Onsetl isl graduall overl severall days
Leadsl tol comal andl deathl ifl untreated
Q:l Isl hyperglycemicl hyperosmolarl statel (HHS)l morel commonl inl typel 1l orl typel 2l
DM?l
Answer:
Typel 2
Q:l Whatl arel riskl factorsl forl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Osmoticl diuresisl duel tol lackl ofl sufficientl insulinl froml undiagnosedl orl poorlyl managedl
DM
Osmoticl diuresisl froml inadequatel fluidl orl poorl kidneyl function
Olderl adultsl (50-70l yearsl old)l whol havel typel 2l DM
Infection,l stress,l existingl medicall conditionsl (MI,l CVA,l sepsis)
Medl effectsl (glucocorticoids,l thiazidel diuretics,l phenytoin,l betal blocker,l calciuml channell
blockers)
Therel isl enoughl insulinl tol preventl ketosisl butl notl enoughl tol preventl hyperglycemia
,Q:l Whatl arel expectedl findingsl ofl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
3l P's
Weightl loss
Blurredl vision,l headache,l weakness
Orthostaticl hypotension
Alteredl mentall status
Seizures,l myoclonicl jerkingl froml hyperosmolarityl greaterl thanl 350l mOsm/L
Reversiblel paralysisl froml hyperosmolarity
Q:l Whatl labl resultsl arel seenl withl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Bloodl glucosel >l 600l mg/dL
Checkl baselinel K+l andl Na+
BUNl >l 30l mg/dL,l creatininel >l 1.5l mg/dLl duel tol dehydration
Absencel ofl ketonesl inl bloodl andl urine
Bloodl osmolarityl >l 320l mOsm/L
pHl >l 7.4
HCO3l >l 20l mEq/L
Q:l Whatl isl thel nursingl carel forl DKAl andl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Assessl vitalsl Q15Ml untill stable,l thenl Q4H
Checkl forl indicationsl forl dehydrationl (weightl loss,l decreasedl skinl turgor,l oliguria,l rapid,l
weakl pulse)
Fluidl resuscitationl isl priority
Treatl underlyingl causel (infection),l givel ABX
Administerl isotonicl fluidsl (0.9?l NS,l LR)l followingl byl hypotonicl fluidsl (0.45%l NS)
Hourlyl bloodl glucose
Infusel continuousl regularl insulinl IV,l hasl tol runl onl itsl ownl line
Whenl bloodl glucosel reachesl 250l mg/dL,l switchl IVFl tol 5%l dextrosel tol reducel riskl forl
cerebrall edemal andl hypoglycemia
Monitorl ABG,l electrolytesl andl replacel accordingly
,Q:l Whatl isl thel clientl educationl forl DKAl andl hyperglycemicl hyperosmolarl statel
(HHS)?l
Answer:
Hydratel tol preventl dehydration
Monitorl bloodl glucosel Q4Hl whenl sickl andl keepl takingl insulin
Checkl urinel forl ketonesl ifl bloodl glucosel >l 240l mg/dL
Q:l Inl regardsl tol fluidl replacementl forl DMl andl HHS,l howl isl itl done?l Whatl kindl ofl
fluidsl arel used?l
Answer:
Twol bagl system
Bagl 1:l 0.9%l NaCl,l 20l mEql KCl,l 20l mEql KPhos
Bagl 2:l Dextrosel 10%,l 0.9%l NaCl,l 20l mEql KCl,l 20l mEql KPhos
Q:l Ifl al patient'sl seruml glucosel isl greaterl thanl 300,l whatl wouldl thel ratel bel forl bagl
1l andl 2l whenl treatingl DMl andl HHSl usingl thel twol bagl system?l
Answer:
Bagl 1:l ratel ofl 250l mL/hr
Bagl 2:l 0
Q:l Ifl al patient'sl seruml glucosel isl lessl thanl 200-300,l whatl wouldl thel ratel bel forl bagl
1l andl 2l whenl treatingl DMl andl HHSl usingl thel twol bagl system?l
Answer:
Bagl 1:l ratel ofl 125l mL/hr
Bagl 2:l ratel ofl 125l mL/hr
Q:l Ifl al patient'sl seruml glucosel isl lessl thanl 200,l whatl wouldl thel ratel bel forl bagl 1l
andl 2l whenl treatingl DMl andl HHSl usingl thel twol bagl system?l
Answer:
Bagl 1:l 0
Bagl 2:l ratel ofl 250l mL/hr
, Q:l Whatl isl acromegaly?l
Answer:
Excessl growthl hormones
Affectsl bothl gendersl equally
Q:l Whyl doesl acromegalyl happen?l
Answer:
Occursl becausel ofl al benignl GHl secretingl pituitaryl adenomal (tumor)
Q:l Atl whatl agel isl acromegalyl typicallyl diagnosedl at?l
Answer:
40-45l yearsl old
Q:l Whatl arel expectedl findingsl ofl acromegaly?l
Answer:
Protrudingl jaw
Headache
Visuall disturbances
Enlargedl handsl andl feet
Increasingl handl size
Sleepl apnea
Menstruall changes
Coarsel faciall features
Q:l Whatl diagnosticsl arel donel forl acromegaly?l Whyl arel theyl done?l
Answer:
X-rayl ofl thel skull:l identifyl abnormalitiesl ofl thel sellal turcica
CTl orl MRIl ofl head:l identifyl softl tissuel lesion
Cerebrall angiography:l evaluatel forl thel presencel ofl vascularl malformationl orl aneurysms
GHl suppressionl test:l clientsl withl acromegalyl willl seel al slightl decreasel orl nol decreasel
inl GH,l telll patientl tol consumel nothingl butl waterl forl 6-8l hrsl precedingl thel test
Advancedl Medicall Surgicall Healthl
Nursing|l WCUl (Latestl 2026/l 2027l
Update)l Review|l 100%l Verifiedl Questionsl
&l Answersl |l Gradel A
Q:l Whatl isl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Lifel threatening,l profoundl hyperglycemial ofl 600l mg/dLl orl greater,l hyperosmolarityl
leadingl tol dehydrationl withl anl absencel ofl ketosis
Onsetl isl graduall overl severall days
Leadsl tol comal andl deathl ifl untreated
Q:l Isl hyperglycemicl hyperosmolarl statel (HHS)l morel commonl inl typel 1l orl typel 2l
DM?l
Answer:
Typel 2
Q:l Whatl arel riskl factorsl forl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Osmoticl diuresisl duel tol lackl ofl sufficientl insulinl froml undiagnosedl orl poorlyl managedl
DM
Osmoticl diuresisl froml inadequatel fluidl orl poorl kidneyl function
Olderl adultsl (50-70l yearsl old)l whol havel typel 2l DM
Infection,l stress,l existingl medicall conditionsl (MI,l CVA,l sepsis)
Medl effectsl (glucocorticoids,l thiazidel diuretics,l phenytoin,l betal blocker,l calciuml channell
blockers)
Therel isl enoughl insulinl tol preventl ketosisl butl notl enoughl tol preventl hyperglycemia
,Q:l Whatl arel expectedl findingsl ofl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
3l P's
Weightl loss
Blurredl vision,l headache,l weakness
Orthostaticl hypotension
Alteredl mentall status
Seizures,l myoclonicl jerkingl froml hyperosmolarityl greaterl thanl 350l mOsm/L
Reversiblel paralysisl froml hyperosmolarity
Q:l Whatl labl resultsl arel seenl withl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Bloodl glucosel >l 600l mg/dL
Checkl baselinel K+l andl Na+
BUNl >l 30l mg/dL,l creatininel >l 1.5l mg/dLl duel tol dehydration
Absencel ofl ketonesl inl bloodl andl urine
Bloodl osmolarityl >l 320l mOsm/L
pHl >l 7.4
HCO3l >l 20l mEq/L
Q:l Whatl isl thel nursingl carel forl DKAl andl hyperglycemicl hyperosmolarl statel (HHS)?l
Answer:
Assessl vitalsl Q15Ml untill stable,l thenl Q4H
Checkl forl indicationsl forl dehydrationl (weightl loss,l decreasedl skinl turgor,l oliguria,l rapid,l
weakl pulse)
Fluidl resuscitationl isl priority
Treatl underlyingl causel (infection),l givel ABX
Administerl isotonicl fluidsl (0.9?l NS,l LR)l followingl byl hypotonicl fluidsl (0.45%l NS)
Hourlyl bloodl glucose
Infusel continuousl regularl insulinl IV,l hasl tol runl onl itsl ownl line
Whenl bloodl glucosel reachesl 250l mg/dL,l switchl IVFl tol 5%l dextrosel tol reducel riskl forl
cerebrall edemal andl hypoglycemia
Monitorl ABG,l electrolytesl andl replacel accordingly
,Q:l Whatl isl thel clientl educationl forl DKAl andl hyperglycemicl hyperosmolarl statel
(HHS)?l
Answer:
Hydratel tol preventl dehydration
Monitorl bloodl glucosel Q4Hl whenl sickl andl keepl takingl insulin
Checkl urinel forl ketonesl ifl bloodl glucosel >l 240l mg/dL
Q:l Inl regardsl tol fluidl replacementl forl DMl andl HHS,l howl isl itl done?l Whatl kindl ofl
fluidsl arel used?l
Answer:
Twol bagl system
Bagl 1:l 0.9%l NaCl,l 20l mEql KCl,l 20l mEql KPhos
Bagl 2:l Dextrosel 10%,l 0.9%l NaCl,l 20l mEql KCl,l 20l mEql KPhos
Q:l Ifl al patient'sl seruml glucosel isl greaterl thanl 300,l whatl wouldl thel ratel bel forl bagl
1l andl 2l whenl treatingl DMl andl HHSl usingl thel twol bagl system?l
Answer:
Bagl 1:l ratel ofl 250l mL/hr
Bagl 2:l 0
Q:l Ifl al patient'sl seruml glucosel isl lessl thanl 200-300,l whatl wouldl thel ratel bel forl bagl
1l andl 2l whenl treatingl DMl andl HHSl usingl thel twol bagl system?l
Answer:
Bagl 1:l ratel ofl 125l mL/hr
Bagl 2:l ratel ofl 125l mL/hr
Q:l Ifl al patient'sl seruml glucosel isl lessl thanl 200,l whatl wouldl thel ratel bel forl bagl 1l
andl 2l whenl treatingl DMl andl HHSl usingl thel twol bagl system?l
Answer:
Bagl 1:l 0
Bagl 2:l ratel ofl 250l mL/hr
, Q:l Whatl isl acromegaly?l
Answer:
Excessl growthl hormones
Affectsl bothl gendersl equally
Q:l Whyl doesl acromegalyl happen?l
Answer:
Occursl becausel ofl al benignl GHl secretingl pituitaryl adenomal (tumor)
Q:l Atl whatl agel isl acromegalyl typicallyl diagnosedl at?l
Answer:
40-45l yearsl old
Q:l Whatl arel expectedl findingsl ofl acromegaly?l
Answer:
Protrudingl jaw
Headache
Visuall disturbances
Enlargedl handsl andl feet
Increasingl handl size
Sleepl apnea
Menstruall changes
Coarsel faciall features
Q:l Whatl diagnosticsl arel donel forl acromegaly?l Whyl arel theyl done?l
Answer:
X-rayl ofl thel skull:l identifyl abnormalitiesl ofl thel sellal turcica
CTl orl MRIl ofl head:l identifyl softl tissuel lesion
Cerebrall angiography:l evaluatel forl thel presencel ofl vascularl malformationl orl aneurysms
GHl suppressionl test:l clientsl withl acromegalyl willl seel al slightl decreasel orl nol decreasel
inl GH,l telll patientl tol consumel nothingl butl waterl forl 6-8l hrsl precedingl thel test
