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
SECTION 1: ENDOCRINE DISORDERS (Questions 1-15)
Q1: A 24-year-old patient with Type 1 diabetes presents to the emergency department with
fruity breath, Kussmaul respirations, and blood glucose of 485 mg/dL. Arterial blood gas shows
pH 7.28, PaCO2 28 mmHg, HCO3 14 mEq/L. Which nursing intervention is the priority?
A. Administer regular insulin IV push immediately
B. Initiate 0.9% normal saline at 1 L/hour [CORRECT]
C. Check urine ketones before starting any treatment
D. Administer sodium bicarbonate IV to correct acidosis
Correct Answer: B
Rationale: This patient presents with diabetic ketoacidosis (DKA). The priority intervention is
fluid resuscitation with isotonic saline. DKA causes profound dehydration (3-6 L deficit) due to
osmotic diuresis. Per ADA 2024 guidelines and AACN standards, aggressive IV fluid replacement
restores perfusion, begins correcting hyperglycemia through dilution, and prevents
cardiovascular collapse. Insulin should NOT be started until potassium is verified >3.3 mEq/L
(insulin drives K+ intracellularly and can cause fatal arrhythmias). Option A is incorrect without
fluid resuscitation first and without knowing potassium status. Option C delays critical care.
Option D is contraindicated unless pH <6.9; bicarbonate can worsen intracellular acidosis and
cause paradoxical CSF acidosis.
Q2: A patient with Type 2 diabetes is prescribed metformin 1000 mg BID. Which statement by
the patient indicates understanding of safe medication administration?
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 catch up"
D. "I can drink alcohol regularly while taking this medication"
,Correct Answer: B
Rationale: Metformin is contraindicated with iodinated contrast due to risk of metformin-
associated lactic acidosis (MALA). The FDA recommends withholding metformin before and 48
hours after contrast procedures, with renal function reassessment. Option A is incorrect—
metformin should be taken with food to reduce GI upset. Option C is dangerous and can cause
hypoglycemia or lactic acidosis. Option D is unsafe; alcohol increases hypoglycemia risk and
lactic acidosis potential.
Q3: A 58-year-old patient with newly diagnosed hyperthyroidism is started on methimazole. The
nurse should monitor for which life-threatening adverse effect?
A. Hypoglycemia
B. Agranulocytosis [CORRECT]
C. Bradycardia
D. Hyperkalemia
Correct Answer: B
Rationale: Agranulocytosis (neutrophils <500/μL) is a rare but fatal adverse effect of antithyroid
medications (methimazole, PTU) occurring in 0.1-0.5% of patients. The nurse must teach
patients to report fever, sore throat, or signs of infection immediately. Complete blood count
with differential is warranted if symptoms develop. Option A is not associated. Option C is
opposite—hyperthyroidism causes tachycardia; treatment normalizes rate. Option D is
unrelated.
Q4: [SATA] A patient with Addison's disease is admitted with acute adrenal crisis. Which
interventions should the nurse implement? (Select all that apply.)
A. Administer hydrocortisone 100 mg IV bolus immediately [CORRECT]
B. Draw blood for cortisol and ACTH levels before giving steroids [CORRECT]
C. Give 5% dextrose in water as the primary fluid replacement
D. Monitor for hyperkalemia and hyponatremia [CORRECT]
E. Place the patient in Trendelenburg position
Correct Answers: A, B, D
Rationale: Adrenal crisis is life-threatening hypotension and shock from cortisol deficiency. A:
Hydrocortisone is the drug of choice—provides glucocorticoid and mineralocorticoid activity. B:
Baseline labs must be drawn before steroid administration, though treatment should not be
, delayed >30 minutes if drawing is difficult. D: Classic electrolyte pattern is hyperkalemia
(aldosterone deficiency) and hyponatremia (cortisol deficiency, SIADH-like effect). C is
incorrect—D5W lacks sodium; these patients need 0.9% saline with dextrose if hypoglycemic. E
is incorrect—Trendelenburg is contraindicated in shock; elevate legs 20-30 degrees or supine.
Q5: A patient with Cushing's syndrome is post-operative following transsphenoidal
hypophysectomy. Which assessment finding requires immediate intervention?
A. Urine output of 250 mL in 4 hours
B. Clear nasal drainage with glucose test strip reading of 3+ [CORRECT]
C. Blood pressure 148/92 mmHg
D. Complaint of headache rated 6/10
Correct Answer: B
Rationale: Clear, glucose-positive nasal drainage indicates cerebrospinal fluid (CSF) rhinorrhea
from surgical disruption of the dura. This places the patient at risk for meningitis and requires
immediate neurosurgical notification, head of bed elevation, and antibiotic prophylaxis. Option
A is expected post-op with fluid restriction. Option C is mild hypertension common in Cushing's.
Option D is expected post-craniotomy but requires monitoring, not immediate intervention like
CSF leak.
Q6: A patient with Type 2 diabetes has the following morning labs: fasting glucose 142 mg/dL,
HbA1c 8.2%, creatinine 1.8 mg/dL, eGFR 38 mL/min/1.73m². Which medication adjustment is
indicated?
A. Increase metformin dose to improve glycemic control
B. Discontinue metformin and consider insulin or GLP-1 receptor agonist [CORRECT]
C. Add glyburide for better post-prandial control
D. Continue current regimen; these values are acceptable
Correct Answer: B
Rationale: The eGFR of 38 mL/min/1.73m² (Stage 3b CKD) contraindicates metformin due to
lactic acidosis risk. FDA guidelines: contraindicated if eGFR <30; use with caution and consider
discontinuation if 30-45. HbA1c 8.2% exceeds ADA target <7% for most adults. Insulin or renally-
cleared agents (GLP-1 RAs with dose adjustment, DPP-4 inhibitors) are preferred. Option A is
dangerous. Option C adds risk—glyburide is contraindicated in renal impairment (hypoglycemia
risk). Option D ignores abnormal values.
ACTUAL PRACTICE EXAM 2026/2027 | Verified
Questions and Answers | Aligned to Fortis Curriculum &
NCLEX Style | Grade A Target | Pass Guaranteed
SECTION 1: ENDOCRINE DISORDERS (Questions 1-15)
Q1: A 24-year-old patient with Type 1 diabetes presents to the emergency department with
fruity breath, Kussmaul respirations, and blood glucose of 485 mg/dL. Arterial blood gas shows
pH 7.28, PaCO2 28 mmHg, HCO3 14 mEq/L. Which nursing intervention is the priority?
A. Administer regular insulin IV push immediately
B. Initiate 0.9% normal saline at 1 L/hour [CORRECT]
C. Check urine ketones before starting any treatment
D. Administer sodium bicarbonate IV to correct acidosis
Correct Answer: B
Rationale: This patient presents with diabetic ketoacidosis (DKA). The priority intervention is
fluid resuscitation with isotonic saline. DKA causes profound dehydration (3-6 L deficit) due to
osmotic diuresis. Per ADA 2024 guidelines and AACN standards, aggressive IV fluid replacement
restores perfusion, begins correcting hyperglycemia through dilution, and prevents
cardiovascular collapse. Insulin should NOT be started until potassium is verified >3.3 mEq/L
(insulin drives K+ intracellularly and can cause fatal arrhythmias). Option A is incorrect without
fluid resuscitation first and without knowing potassium status. Option C delays critical care.
Option D is contraindicated unless pH <6.9; bicarbonate can worsen intracellular acidosis and
cause paradoxical CSF acidosis.
Q2: A patient with Type 2 diabetes is prescribed metformin 1000 mg BID. Which statement by
the patient indicates understanding of safe medication administration?
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 catch up"
D. "I can drink alcohol regularly while taking this medication"
,Correct Answer: B
Rationale: Metformin is contraindicated with iodinated contrast due to risk of metformin-
associated lactic acidosis (MALA). The FDA recommends withholding metformin before and 48
hours after contrast procedures, with renal function reassessment. Option A is incorrect—
metformin should be taken with food to reduce GI upset. Option C is dangerous and can cause
hypoglycemia or lactic acidosis. Option D is unsafe; alcohol increases hypoglycemia risk and
lactic acidosis potential.
Q3: A 58-year-old patient with newly diagnosed hyperthyroidism is started on methimazole. The
nurse should monitor for which life-threatening adverse effect?
A. Hypoglycemia
B. Agranulocytosis [CORRECT]
C. Bradycardia
D. Hyperkalemia
Correct Answer: B
Rationale: Agranulocytosis (neutrophils <500/μL) is a rare but fatal adverse effect of antithyroid
medications (methimazole, PTU) occurring in 0.1-0.5% of patients. The nurse must teach
patients to report fever, sore throat, or signs of infection immediately. Complete blood count
with differential is warranted if symptoms develop. Option A is not associated. Option C is
opposite—hyperthyroidism causes tachycardia; treatment normalizes rate. Option D is
unrelated.
Q4: [SATA] A patient with Addison's disease is admitted with acute adrenal crisis. Which
interventions should the nurse implement? (Select all that apply.)
A. Administer hydrocortisone 100 mg IV bolus immediately [CORRECT]
B. Draw blood for cortisol and ACTH levels before giving steroids [CORRECT]
C. Give 5% dextrose in water as the primary fluid replacement
D. Monitor for hyperkalemia and hyponatremia [CORRECT]
E. Place the patient in Trendelenburg position
Correct Answers: A, B, D
Rationale: Adrenal crisis is life-threatening hypotension and shock from cortisol deficiency. A:
Hydrocortisone is the drug of choice—provides glucocorticoid and mineralocorticoid activity. B:
Baseline labs must be drawn before steroid administration, though treatment should not be
, delayed >30 minutes if drawing is difficult. D: Classic electrolyte pattern is hyperkalemia
(aldosterone deficiency) and hyponatremia (cortisol deficiency, SIADH-like effect). C is
incorrect—D5W lacks sodium; these patients need 0.9% saline with dextrose if hypoglycemic. E
is incorrect—Trendelenburg is contraindicated in shock; elevate legs 20-30 degrees or supine.
Q5: A patient with Cushing's syndrome is post-operative following transsphenoidal
hypophysectomy. Which assessment finding requires immediate intervention?
A. Urine output of 250 mL in 4 hours
B. Clear nasal drainage with glucose test strip reading of 3+ [CORRECT]
C. Blood pressure 148/92 mmHg
D. Complaint of headache rated 6/10
Correct Answer: B
Rationale: Clear, glucose-positive nasal drainage indicates cerebrospinal fluid (CSF) rhinorrhea
from surgical disruption of the dura. This places the patient at risk for meningitis and requires
immediate neurosurgical notification, head of bed elevation, and antibiotic prophylaxis. Option
A is expected post-op with fluid restriction. Option C is mild hypertension common in Cushing's.
Option D is expected post-craniotomy but requires monitoring, not immediate intervention like
CSF leak.
Q6: A patient with Type 2 diabetes has the following morning labs: fasting glucose 142 mg/dL,
HbA1c 8.2%, creatinine 1.8 mg/dL, eGFR 38 mL/min/1.73m². Which medication adjustment is
indicated?
A. Increase metformin dose to improve glycemic control
B. Discontinue metformin and consider insulin or GLP-1 receptor agonist [CORRECT]
C. Add glyburide for better post-prandial control
D. Continue current regimen; these values are acceptable
Correct Answer: B
Rationale: The eGFR of 38 mL/min/1.73m² (Stage 3b CKD) contraindicates metformin due to
lactic acidosis risk. FDA guidelines: contraindicated if eGFR <30; use with caution and consider
discontinuation if 30-45. HbA1c 8.2% exceeds ADA target <7% for most adults. Insulin or renally-
cleared agents (GLP-1 RAs with dose adjustment, DPP-4 inhibitors) are preferred. Option A is
dangerous. Option C adds risk—glyburide is contraindicated in renal impairment (hypoglycemia
risk). Option D ignores abnormal values.
