NUR 265 MEDICAL-SURGICAL NURSING I EXAM 2 2026/2027
| Galen College Two Versions | 100% Correct Answers with
Detailed Rationales | GRADED A | Pass Guaranteed
VERSION A
Unit 1: Endocrine Disorders (20 Questions)
Q1 (Version A): A 58-year-old male with Type 2 diabetes mellitus presents to the
emergency department with confusion, Kussmaul respirations, and a fruity breath odor.
His blood glucose is 485 mg/dL, pH 7.25, HCO3 18 mEq/L, and ketones are positive in
urine. Which nursing intervention is the priority?
A. Administer regular insulin via IV bolus followed by continuous infusion
B. Immediately infuse 0.45% normal saline at 1000 mL/hr
C. Begin potassium replacement therapy at 20 mEq/hr IV
D. Administer sodium bicarbonate to correct acidosis [CORRECT]
E. Insert nasogastric tube for gastric decompression
Correct Answer: D
,Rationale: This patient is in diabetic ketoacidosis (DKA) with severe metabolic acidosis
(pH 7.25). While fluid resuscitation and insulin therapy are critical, the priority when pH <
7.25 is correcting the life-threatening acidosis to prevent cardiac dysrhythmias and
hypotension. Sodium bicarbonate is indicated for severe acidosis (pH < 7.25) to prevent
cardiovascular collapse. Option A (insulin) is essential but secondary to immediate
acidosis correction in this critical range. Option B (0.45% NS) is inappropriate
initially—isotonic 0.9% NS is preferred for initial fluid resuscitation in DKA. Option C
(potassium) is dangerous without knowing current potassium levels; insulin
administration will drive potassium intracellularly, but replacement should not precede
acidosis management or be given without cardiac monitoring. Option E is unnecessary
and delays critical interventions. This aligns with Galen College NUR 265 objective:
"Prioritize interventions for patients with endocrine emergencies based on
pathophysiological changes."
Q2 (Version A): A 45-year-old female with Graves' disease is admitted for thyroid storm.
Her vital signs are: T 104.2°F, HR 158 bpm (irregular), BP 180/110 mmHg, RR 28/min.
Which medications should the nurse anticipate administering? Select all that apply.
A. Propylthiouracil (PTU)
B. Propranolol
C. Hydrocortisone
D. Lugol's solution (potassium iodide)
,E. Methimazole
F. Aspirin
Correct Answer: A, B, C, D
Rationale: Thyroid storm management requires a multi-drug approach: PTU (A) blocks
new hormone synthesis and peripheral T4-to-T3 conversion; propranolol (B) controls
adrenergic symptoms and tachycardia; hydrocortisone (C) treats possible adrenal
insufficiency and blocks T4-to-T3 conversion; Lugol's solution (D) inhibits thyroid
hormone release (given 1 hour after antithyroid drug). Methimazole (E) is incorrect for
thyroid storm—PTU is preferred due to its additional peripheral conversion blockade.
Aspirin (F) is contraindicated because it displaces thyroid hormone from binding
proteins, potentially worsening the crisis. This reflects NCLEX clinical judgment:
recognizing appropriate pharmacological interventions for endocrine emergencies.
Q3 (Version A): A nurse is caring for a patient with Addison's disease who reports
weakness, dizziness upon standing, and has a serum sodium of 128 mEq/L and
potassium of 5.8 mEq/L. The patient missed their morning hydrocortisone dose. What
is the nurse's priority action?
A. Administer the missed hydrocortisone dose immediately [CORRECT]
B. Increase dietary sodium intake
C. Administer potassium-lowering resin
, D. Place the patient in Trendelenburg position
Correct Answer: A
Rationale: The patient is showing signs of adrenal crisis (hypotension, hyponatremia,
hyperkalemia, weakness) triggered by missed glucocorticoid replacement. Immediate
hydrocortisone replacement is life-saving to prevent cardiovascular collapse. While B
(sodium increase) addresses hyponatremia, it doesn't treat the underlying cortisol
deficiency. C (potassium resin) is inappropriate—hyperkalemia will resolve with cortisol
replacement, which drives potassium intracellularly. D (Trendelenburg) may help
hypotension temporarily but doesn't address the physiological emergency. This
demonstrates Galen College emphasis on "recognizing and responding to
life-threatening endocrine complications."
Q4 (Version A): Order the following nursing interventions for a newly admitted patient
with DKA from first to last priority:
1. Begin continuous regular insulin infusion at 0.1 units/kg/hr
2. Obtain arterial blood gas and serum potassium levels
3. Administer 1-2 liters 0.9% normal saline over first 2 hours
4. Insert large-bore IV access and begin cardiac monitoring
A. 4, 2, 3, 1
B. 2, 4, 3, 1
C. 4, 3, 2, 1 [CORRECT]
| Galen College Two Versions | 100% Correct Answers with
Detailed Rationales | GRADED A | Pass Guaranteed
VERSION A
Unit 1: Endocrine Disorders (20 Questions)
Q1 (Version A): A 58-year-old male with Type 2 diabetes mellitus presents to the
emergency department with confusion, Kussmaul respirations, and a fruity breath odor.
His blood glucose is 485 mg/dL, pH 7.25, HCO3 18 mEq/L, and ketones are positive in
urine. Which nursing intervention is the priority?
A. Administer regular insulin via IV bolus followed by continuous infusion
B. Immediately infuse 0.45% normal saline at 1000 mL/hr
C. Begin potassium replacement therapy at 20 mEq/hr IV
D. Administer sodium bicarbonate to correct acidosis [CORRECT]
E. Insert nasogastric tube for gastric decompression
Correct Answer: D
,Rationale: This patient is in diabetic ketoacidosis (DKA) with severe metabolic acidosis
(pH 7.25). While fluid resuscitation and insulin therapy are critical, the priority when pH <
7.25 is correcting the life-threatening acidosis to prevent cardiac dysrhythmias and
hypotension. Sodium bicarbonate is indicated for severe acidosis (pH < 7.25) to prevent
cardiovascular collapse. Option A (insulin) is essential but secondary to immediate
acidosis correction in this critical range. Option B (0.45% NS) is inappropriate
initially—isotonic 0.9% NS is preferred for initial fluid resuscitation in DKA. Option C
(potassium) is dangerous without knowing current potassium levels; insulin
administration will drive potassium intracellularly, but replacement should not precede
acidosis management or be given without cardiac monitoring. Option E is unnecessary
and delays critical interventions. This aligns with Galen College NUR 265 objective:
"Prioritize interventions for patients with endocrine emergencies based on
pathophysiological changes."
Q2 (Version A): A 45-year-old female with Graves' disease is admitted for thyroid storm.
Her vital signs are: T 104.2°F, HR 158 bpm (irregular), BP 180/110 mmHg, RR 28/min.
Which medications should the nurse anticipate administering? Select all that apply.
A. Propylthiouracil (PTU)
B. Propranolol
C. Hydrocortisone
D. Lugol's solution (potassium iodide)
,E. Methimazole
F. Aspirin
Correct Answer: A, B, C, D
Rationale: Thyroid storm management requires a multi-drug approach: PTU (A) blocks
new hormone synthesis and peripheral T4-to-T3 conversion; propranolol (B) controls
adrenergic symptoms and tachycardia; hydrocortisone (C) treats possible adrenal
insufficiency and blocks T4-to-T3 conversion; Lugol's solution (D) inhibits thyroid
hormone release (given 1 hour after antithyroid drug). Methimazole (E) is incorrect for
thyroid storm—PTU is preferred due to its additional peripheral conversion blockade.
Aspirin (F) is contraindicated because it displaces thyroid hormone from binding
proteins, potentially worsening the crisis. This reflects NCLEX clinical judgment:
recognizing appropriate pharmacological interventions for endocrine emergencies.
Q3 (Version A): A nurse is caring for a patient with Addison's disease who reports
weakness, dizziness upon standing, and has a serum sodium of 128 mEq/L and
potassium of 5.8 mEq/L. The patient missed their morning hydrocortisone dose. What
is the nurse's priority action?
A. Administer the missed hydrocortisone dose immediately [CORRECT]
B. Increase dietary sodium intake
C. Administer potassium-lowering resin
, D. Place the patient in Trendelenburg position
Correct Answer: A
Rationale: The patient is showing signs of adrenal crisis (hypotension, hyponatremia,
hyperkalemia, weakness) triggered by missed glucocorticoid replacement. Immediate
hydrocortisone replacement is life-saving to prevent cardiovascular collapse. While B
(sodium increase) addresses hyponatremia, it doesn't treat the underlying cortisol
deficiency. C (potassium resin) is inappropriate—hyperkalemia will resolve with cortisol
replacement, which drives potassium intracellularly. D (Trendelenburg) may help
hypotension temporarily but doesn't address the physiological emergency. This
demonstrates Galen College emphasis on "recognizing and responding to
life-threatening endocrine complications."
Q4 (Version A): Order the following nursing interventions for a newly admitted patient
with DKA from first to last priority:
1. Begin continuous regular insulin infusion at 0.1 units/kg/hr
2. Obtain arterial blood gas and serum potassium levels
3. Administer 1-2 liters 0.9% normal saline over first 2 hours
4. Insert large-bore IV access and begin cardiac monitoring
A. 4, 2, 3, 1
B. 2, 4, 3, 1
C. 4, 3, 2, 1 [CORRECT]
