NUR209 / NUR 209 Medical Surgical Nursing II Exam 2
ACTUAL PRACTICE EXAM 2026/2027 | Verified
Questions and Answers | Aligned to Fortis Curriculum &
NCLEX Style | Grade A Target | Pass Guaranteed
Q1: A 24-year-old patient with Type 1 diabetes presents to the ED with fruity breath, Kussmaul
respirations, blood glucose of 498 mg/dL, and pH 7.28. The nurse notes the patient is lethargic
but arousable. Which assessment finding requires immediate intervention?
A. Potassium level of 5.2 mEq/L
B. Urine output of 40 mL/hr
C. Serum osmolality of 310 mOsm/kg
D. Deep, rapid breathing pattern [CORRECT]
Correct Answer: D
Rationale: This patient presents with diabetic ketoacidosis (DKA) evidenced by hyperglycemia,
metabolic acidosis (pH <7.35), and Kussmaul respirations (compensatory hyperventilation for
metabolic acidosis). While all options represent DKA findings, the deep, rapid breathing pattern
(Kussmaul respirations) indicates severe acidosis and impending respiratory exhaustion.
According to ADA guidelines, respiratory fatigue leading to inability to compensate is a critical
sign of decompensation requiring immediate airway intervention or ICU transfer. Potassium of
5.2 (A) is expected in DKA due to extracellular shift from acidosis and will correct with insulin
therapy. Urine output 40 mL/hr (B) is adequate. Serum osmolality 310 (C) is mildly elevated but
not immediately life-threatening.
Q2: A patient with Type 2 diabetes is prescribed metformin 1000 mg PO BID. Which statement
by the patient indicates understanding of medication safety?
A. "I should take this medication on an empty stomach for better absorption."
B. "I need to stop this medication 48 hours before any imaging with contrast dye." [CORRECT]
C. "If I miss a dose, I should double the next dose to maintain therapeutic levels."
D. "This medication will eliminate my need for blood glucose monitoring."
Correct Answer: B
Rationale: Metformin is contraindicated with iodinated contrast due to risk of metformin-
associated lactic acidosis (MALA), particularly if renal function is compromised. The ACR and
,ADA guidelines require holding metformin 48 hours prior to contrast studies and resuming only
after renal function is confirmed stable. Option A is incorrect—metformin should be taken with
food to reduce GI upset. Option C is dangerous—dose doubling increases toxicity risk. Option D
is incorrect—all diabetic patients require ongoing glucose monitoring regardless of medication
regimen.
Q3: A patient with hyperthyroidism is started on methimazole. Which laboratory value indicates
a potential life-threatening complication requiring immediate provider notification?
A. TSH 0.1 mIU/L (low)
B. WBC 2,800/mm³ with absolute neutrophil count 800 [CORRECT]
C. T3 180 ng/dL (elevated)
D. Liver enzymes 2× upper limit of normal
Correct Answer: B
Rationale: Agranulocytosis (neutrophils <500/mm³ or WBC <2,000/mm³) is a rare but fatal
adverse effect of antithyroid medications (methimazole, PTU) occurring in 0.2-0.5% of patients.
The nurse must immediately notify the provider and hold the medication. The patient requires
isolation and protection from infection. While abnormal TSH (A) and elevated T3 (C) indicate
ongoing hyperthyroidism, they are not immediately life-threatening. Mild LFT elevation (D) may
occur but does not require immediate discontinuation unless severe (>3× ULN).
Q4: [SATA] A nurse is caring for a patient admitted with Addisonian crisis. Which nursing
interventions are appropriate? (Select all that apply.)
A. Administer hydrocortisone IV as prescribed [CORRECT]
B. Restrict sodium intake to prevent fluid overload
C. Monitor for hyperglycemia and administer insulin per sliding scale
D. Assess for orthostatic hypotension and tachycardia [CORRECT]
E. Provide emotional support and education about lifelong steroid replacement [CORRECT]
F. Administer potassium supplements to correct hypokalemia
Correct Answers: A, D, E
Rationale: Addisonian crisis (acute adrenal insufficiency) requires immediate glucocorticoid
replacement (A) to prevent cardiovascular collapse. Patients present with hypotension,
tachycardia, and orthostatic changes (D) due to mineralocorticoid deficiency and volume
depletion. Lifelong education (E) is essential as adrenal insufficiency requires permanent
, replacement. Sodium restriction (B) is contraindicated—these patients require sodium
replacement and fluids. Hyperglycemia (C) is unlikely; these patients typically have
hypoglycemia from lack of cortisol. Potassium supplements (F) are dangerous—Addison's
causes hyperkalemia, not hypokalemia, due to aldosterone deficiency.
Q5: A patient with Cushing's syndrome is post-operative following transsphenoidal
hypophysectomy. Which assessment finding indicates the development of diabetes insipidus
(DI), a potential complication?
A. Urine specific gravity 1.035 and output 800 mL/8hr
B. Serum sodium 148 mEq/L with urine output 4,500 mL/24hr and specific gravity 1.002
[CORRECT]
C. Blood glucose 245 mg/dL with polyuria and polydipsia
D. Hypertension and hypokalemia
Correct Answer: B
Rationale: Diabetes insipidus results from ADH deficiency post-pituitary surgery, causing
inability to concentrate urine. Diagnostic criteria include: massive polyuria (>3L/day), dilute
urine (specific gravity <1.005, osmolality <200 mOsm/kg), and hypernatremia from free water
loss. Option A describes concentrated urine (increased specific gravity) seen in SIADH or
dehydration. Option C describes diabetes mellitus (hyperglycemia). Option D describes
hyperaldosteronism or continued Cushing's, not DI.
Q6: A patient with Type 2 diabetes has a fasting blood glucose of 142 mg/dL at 0600. The
patient is NPO for surgery scheduled at 1000. The nurse administers the patient's usual morning
NPH insulin dose. At 0830, the patient becomes diaphoretic and confused. What is the priority
nursing action?
A. Administer IV dextrose immediately
B. Check capillary blood glucose and treat per hypoglycemia protocol [CORRECT]
C. Notify the surgeon to cancel the surgery
D. Give the patient orange juice to drink
Correct Answer: B
Rationale: The patient exhibits classic signs of hypoglycemia (diaphoresis, confusion) likely due
to NPH insulin administration while NPO. The ADA and AORN guidelines for perioperative
diabetes management recommend holding short-acting insulin and reducing NPH when NPO.
ACTUAL PRACTICE EXAM 2026/2027 | Verified
Questions and Answers | Aligned to Fortis Curriculum &
NCLEX Style | Grade A Target | Pass Guaranteed
Q1: A 24-year-old patient with Type 1 diabetes presents to the ED with fruity breath, Kussmaul
respirations, blood glucose of 498 mg/dL, and pH 7.28. The nurse notes the patient is lethargic
but arousable. Which assessment finding requires immediate intervention?
A. Potassium level of 5.2 mEq/L
B. Urine output of 40 mL/hr
C. Serum osmolality of 310 mOsm/kg
D. Deep, rapid breathing pattern [CORRECT]
Correct Answer: D
Rationale: This patient presents with diabetic ketoacidosis (DKA) evidenced by hyperglycemia,
metabolic acidosis (pH <7.35), and Kussmaul respirations (compensatory hyperventilation for
metabolic acidosis). While all options represent DKA findings, the deep, rapid breathing pattern
(Kussmaul respirations) indicates severe acidosis and impending respiratory exhaustion.
According to ADA guidelines, respiratory fatigue leading to inability to compensate is a critical
sign of decompensation requiring immediate airway intervention or ICU transfer. Potassium of
5.2 (A) is expected in DKA due to extracellular shift from acidosis and will correct with insulin
therapy. Urine output 40 mL/hr (B) is adequate. Serum osmolality 310 (C) is mildly elevated but
not immediately life-threatening.
Q2: A patient with Type 2 diabetes is prescribed metformin 1000 mg PO BID. Which statement
by the patient indicates understanding of medication safety?
A. "I should take this medication on an empty stomach for better absorption."
B. "I need to stop this medication 48 hours before any imaging with contrast dye." [CORRECT]
C. "If I miss a dose, I should double the next dose to maintain therapeutic levels."
D. "This medication will eliminate my need for blood glucose monitoring."
Correct Answer: B
Rationale: Metformin is contraindicated with iodinated contrast due to risk of metformin-
associated lactic acidosis (MALA), particularly if renal function is compromised. The ACR and
,ADA guidelines require holding metformin 48 hours prior to contrast studies and resuming only
after renal function is confirmed stable. Option A is incorrect—metformin should be taken with
food to reduce GI upset. Option C is dangerous—dose doubling increases toxicity risk. Option D
is incorrect—all diabetic patients require ongoing glucose monitoring regardless of medication
regimen.
Q3: A patient with hyperthyroidism is started on methimazole. Which laboratory value indicates
a potential life-threatening complication requiring immediate provider notification?
A. TSH 0.1 mIU/L (low)
B. WBC 2,800/mm³ with absolute neutrophil count 800 [CORRECT]
C. T3 180 ng/dL (elevated)
D. Liver enzymes 2× upper limit of normal
Correct Answer: B
Rationale: Agranulocytosis (neutrophils <500/mm³ or WBC <2,000/mm³) is a rare but fatal
adverse effect of antithyroid medications (methimazole, PTU) occurring in 0.2-0.5% of patients.
The nurse must immediately notify the provider and hold the medication. The patient requires
isolation and protection from infection. While abnormal TSH (A) and elevated T3 (C) indicate
ongoing hyperthyroidism, they are not immediately life-threatening. Mild LFT elevation (D) may
occur but does not require immediate discontinuation unless severe (>3× ULN).
Q4: [SATA] A nurse is caring for a patient admitted with Addisonian crisis. Which nursing
interventions are appropriate? (Select all that apply.)
A. Administer hydrocortisone IV as prescribed [CORRECT]
B. Restrict sodium intake to prevent fluid overload
C. Monitor for hyperglycemia and administer insulin per sliding scale
D. Assess for orthostatic hypotension and tachycardia [CORRECT]
E. Provide emotional support and education about lifelong steroid replacement [CORRECT]
F. Administer potassium supplements to correct hypokalemia
Correct Answers: A, D, E
Rationale: Addisonian crisis (acute adrenal insufficiency) requires immediate glucocorticoid
replacement (A) to prevent cardiovascular collapse. Patients present with hypotension,
tachycardia, and orthostatic changes (D) due to mineralocorticoid deficiency and volume
depletion. Lifelong education (E) is essential as adrenal insufficiency requires permanent
, replacement. Sodium restriction (B) is contraindicated—these patients require sodium
replacement and fluids. Hyperglycemia (C) is unlikely; these patients typically have
hypoglycemia from lack of cortisol. Potassium supplements (F) are dangerous—Addison's
causes hyperkalemia, not hypokalemia, due to aldosterone deficiency.
Q5: A patient with Cushing's syndrome is post-operative following transsphenoidal
hypophysectomy. Which assessment finding indicates the development of diabetes insipidus
(DI), a potential complication?
A. Urine specific gravity 1.035 and output 800 mL/8hr
B. Serum sodium 148 mEq/L with urine output 4,500 mL/24hr and specific gravity 1.002
[CORRECT]
C. Blood glucose 245 mg/dL with polyuria and polydipsia
D. Hypertension and hypokalemia
Correct Answer: B
Rationale: Diabetes insipidus results from ADH deficiency post-pituitary surgery, causing
inability to concentrate urine. Diagnostic criteria include: massive polyuria (>3L/day), dilute
urine (specific gravity <1.005, osmolality <200 mOsm/kg), and hypernatremia from free water
loss. Option A describes concentrated urine (increased specific gravity) seen in SIADH or
dehydration. Option C describes diabetes mellitus (hyperglycemia). Option D describes
hyperaldosteronism or continued Cushing's, not DI.
Q6: A patient with Type 2 diabetes has a fasting blood glucose of 142 mg/dL at 0600. The
patient is NPO for surgery scheduled at 1000. The nurse administers the patient's usual morning
NPH insulin dose. At 0830, the patient becomes diaphoretic and confused. What is the priority
nursing action?
A. Administer IV dextrose immediately
B. Check capillary blood glucose and treat per hypoglycemia protocol [CORRECT]
C. Notify the surgeon to cancel the surgery
D. Give the patient orange juice to drink
Correct Answer: B
Rationale: The patient exhibits classic signs of hypoglycemia (diaphoresis, confusion) likely due
to NPH insulin administration while NPO. The ADA and AORN guidelines for perioperative
diabetes management recommend holding short-acting insulin and reducing NPH when NPO.
