NURS 5335 FAMILY 2 MODULE 3 ENDOCRINE AND
NERVOUS REVIEW 2026/2027 | Questions and Answers with
Complete Solutions | Graduate Nursing | Pass Guaranteed -
A+ Graded
Domain 1: Diabetes Mellitus (15 Questions)
Q1: A 42-year-old Hispanic male presents for routine physical. BMI 32 kg/m², blood
pressure 138/88 mmHg, family history of type 2 diabetes in both parents. Fasting
plasma glucose is 126 mg/dL, repeated one week later at 132 mg/dL. He is
asymptomatic. What is the most appropriate next step in management?
A. Repeat fasting glucose in 3 months with lifestyle counseling only
B. Order 75g oral glucose tolerance test (OGTT) to confirm diagnosis
C. Diagnose type 2 diabetes and initiate metformin 500mg daily with lifestyle
modification
D. Order HbA1c to confirm diagnosis before initiating treatment
Correct Answer: C
Rationale: According to ADA Standards of Care 2026, two abnormal fasting plasma
glucose values ≥126 mg/dL on separate days are diagnostic of diabetes in the
appropriate clinical context. This patient has two elevated values (126 and 132 mg/dL),
obesity, hypertension, and strong family history - meeting diagnostic criteria. The ADA
no longer requires confirmatory testing on a separate day if unequivocal hyperglycemia
with classic symptoms exists, or in this case, two abnormal values are already present.
,Option A delays necessary treatment. Option B (OGTT) is unnecessary when fasting
criteria are already met twice. Option D (HbA1c) is optional for confirmation but should
not delay treatment initiation when fasting criteria are clearly met. Metformin is first-line
pharmacotherapy for type 2 diabetes per ADA guidelines, combined with lifestyle
modification. Early intervention prevents beta-cell decline and microvascular
complications.
Q2: A 28-year-old female presents with polyuria, polydipsia, and 15-pound weight loss
over 3 weeks. Random plasma glucose is 342 mg/dL. Physical exam reveals dry
mucous membranes and tachycardia. BMI is 22 kg/m². Which laboratory finding would
best distinguish type 1 from type 2 diabetes in this patient?
A. Fasting C-peptide level <0.6 ng/mL
B. HbA1c >10%
C. Presence of insulin antibodies only
D. Elevated fasting triglycerides >400 mg/dL
Correct Answer: A
Rationale: A low fasting C-peptide level (<0.6 ng/mL, or <0.2 nmol/L) indicates absolute
insulin deficiency, characteristic of type 1 diabetes (T1D). C-peptide is cleaved from
proinsulin in equimolar amounts with insulin, making it a reliable marker of endogenous
insulin production. This patient has classic T1D presentation: young, lean, acute onset
with osmotic symptoms, weight loss, and significant hyperglycemia. Option B (HbA1c
>10%) indicates poor glycemic control but occurs in both T1D and T2D. Option C is
incorrect because while insulin antibodies may be present in T1D, they are not required
,for diagnosis and may be absent, especially in later-onset T1D (LADA). Option D
(elevated triglycerides) is more common in insulin-resistant T2D with metabolic
syndrome. The acute presentation with ketoacidosis risk and low C-peptide confirms
insulin deficiency requiring immediate insulin therapy.
Q3: A 65-year-old male with type 2 diabetes for 12 years presents for follow-up. Current
medications: metformin 1000mg BID, glipizide 10mg daily. HbA1c is 8.9%, eGFR 45
mL/min/1.73m², BMI 28 kg/m². He reports postprandial hyperglycemia and wants to
avoid weight gain. Which medication addition would be most appropriate?
A. Add pioglitazone 30mg daily
B. Add sitagliptin 100mg daily
C. Add empagliflozin 10mg daily
D. Add insulin glargine 10 units at bedtime
Correct Answer: C
Rationale: Empagliflozin (an SGLT2 inhibitor) is the optimal choice for several reasons.
With eGFR 45 mL/min/1.73m², SGLT2 inhibitors remain effective (though
glucose-lowering efficacy diminishes below 45, cardiovascular and renal benefits
persist). The patient has established ASCVD risk (age 65, diabetes duration 12 years,
A1c 8.9%) - SGLT2 inhibitors provide cardiovascular protection and slow diabetic kidney
disease progression independent of glycemic control. Additionally, SGLT2 inhibitors
promote weight loss (2-3 kg average) rather than weight gain, addressing the patient's
preference. Pioglitazone (A) causes weight gain and fluid retention, contraindicated with
reduced eGFR risk. Sitagliptin (B) is weight neutral but less effective (A1c reduction
, 0.5-0.8%) and has cardiovascular safety but not benefit. Insulin (D) would cause weight
gain and increase hypoglycemia risk with sulfonylurea already present. ADA/EASD
guidelines recommend SGLT2 inhibitors with proven CVD benefit for patients with T2D
and established ASCVD or high risk.
Q4: A 24-year-old female with type 1 diabetes uses insulin glargine 24 units at bedtime
and insulin lispro with meals (I:C ratio 1:12, correction 1:50). She checks her CGM at 10
PM and reads 142 mg/dL with steady arrow. She plans to sleep at 11 PM. What is the
most appropriate action?
A. Take 2 units lispro correction and recheck in 2 hours
B. Consume 15g fast-acting carbohydrate before bed
C. No action needed; reading is within target range
D. Reduce bedtime glargine by 20% to prevent nocturnal hypoglycemia
Correct Answer: C
Rationale: With a CGM reading of 142 mg/dL and a steady arrow (indicating stable
glucose), no action is needed before sleep. The ADA target for most adults with T1D is
80-180 mg/dL, and 142 mg/dL with stability is optimal for overnight safety. Option A
(correction insulin) is unnecessary as 142 mg/dL is not hyperglycemic requiring
correction, and stacking insulin increases nocturnal hypoglycemia risk. Option B
(carbohydrate) would cause unnecessary hyperglycemia. Option D (reducing basal) is
inappropriate without a pattern of nocturnal hypoglycemia. The patient should verify the
CGM reading with a fingerstick if symptoms exist, but with steady trend and appropriate
bedtime reading, sleep can proceed safely.
NERVOUS REVIEW 2026/2027 | Questions and Answers with
Complete Solutions | Graduate Nursing | Pass Guaranteed -
A+ Graded
Domain 1: Diabetes Mellitus (15 Questions)
Q1: A 42-year-old Hispanic male presents for routine physical. BMI 32 kg/m², blood
pressure 138/88 mmHg, family history of type 2 diabetes in both parents. Fasting
plasma glucose is 126 mg/dL, repeated one week later at 132 mg/dL. He is
asymptomatic. What is the most appropriate next step in management?
A. Repeat fasting glucose in 3 months with lifestyle counseling only
B. Order 75g oral glucose tolerance test (OGTT) to confirm diagnosis
C. Diagnose type 2 diabetes and initiate metformin 500mg daily with lifestyle
modification
D. Order HbA1c to confirm diagnosis before initiating treatment
Correct Answer: C
Rationale: According to ADA Standards of Care 2026, two abnormal fasting plasma
glucose values ≥126 mg/dL on separate days are diagnostic of diabetes in the
appropriate clinical context. This patient has two elevated values (126 and 132 mg/dL),
obesity, hypertension, and strong family history - meeting diagnostic criteria. The ADA
no longer requires confirmatory testing on a separate day if unequivocal hyperglycemia
with classic symptoms exists, or in this case, two abnormal values are already present.
,Option A delays necessary treatment. Option B (OGTT) is unnecessary when fasting
criteria are already met twice. Option D (HbA1c) is optional for confirmation but should
not delay treatment initiation when fasting criteria are clearly met. Metformin is first-line
pharmacotherapy for type 2 diabetes per ADA guidelines, combined with lifestyle
modification. Early intervention prevents beta-cell decline and microvascular
complications.
Q2: A 28-year-old female presents with polyuria, polydipsia, and 15-pound weight loss
over 3 weeks. Random plasma glucose is 342 mg/dL. Physical exam reveals dry
mucous membranes and tachycardia. BMI is 22 kg/m². Which laboratory finding would
best distinguish type 1 from type 2 diabetes in this patient?
A. Fasting C-peptide level <0.6 ng/mL
B. HbA1c >10%
C. Presence of insulin antibodies only
D. Elevated fasting triglycerides >400 mg/dL
Correct Answer: A
Rationale: A low fasting C-peptide level (<0.6 ng/mL, or <0.2 nmol/L) indicates absolute
insulin deficiency, characteristic of type 1 diabetes (T1D). C-peptide is cleaved from
proinsulin in equimolar amounts with insulin, making it a reliable marker of endogenous
insulin production. This patient has classic T1D presentation: young, lean, acute onset
with osmotic symptoms, weight loss, and significant hyperglycemia. Option B (HbA1c
>10%) indicates poor glycemic control but occurs in both T1D and T2D. Option C is
incorrect because while insulin antibodies may be present in T1D, they are not required
,for diagnosis and may be absent, especially in later-onset T1D (LADA). Option D
(elevated triglycerides) is more common in insulin-resistant T2D with metabolic
syndrome. The acute presentation with ketoacidosis risk and low C-peptide confirms
insulin deficiency requiring immediate insulin therapy.
Q3: A 65-year-old male with type 2 diabetes for 12 years presents for follow-up. Current
medications: metformin 1000mg BID, glipizide 10mg daily. HbA1c is 8.9%, eGFR 45
mL/min/1.73m², BMI 28 kg/m². He reports postprandial hyperglycemia and wants to
avoid weight gain. Which medication addition would be most appropriate?
A. Add pioglitazone 30mg daily
B. Add sitagliptin 100mg daily
C. Add empagliflozin 10mg daily
D. Add insulin glargine 10 units at bedtime
Correct Answer: C
Rationale: Empagliflozin (an SGLT2 inhibitor) is the optimal choice for several reasons.
With eGFR 45 mL/min/1.73m², SGLT2 inhibitors remain effective (though
glucose-lowering efficacy diminishes below 45, cardiovascular and renal benefits
persist). The patient has established ASCVD risk (age 65, diabetes duration 12 years,
A1c 8.9%) - SGLT2 inhibitors provide cardiovascular protection and slow diabetic kidney
disease progression independent of glycemic control. Additionally, SGLT2 inhibitors
promote weight loss (2-3 kg average) rather than weight gain, addressing the patient's
preference. Pioglitazone (A) causes weight gain and fluid retention, contraindicated with
reduced eGFR risk. Sitagliptin (B) is weight neutral but less effective (A1c reduction
, 0.5-0.8%) and has cardiovascular safety but not benefit. Insulin (D) would cause weight
gain and increase hypoglycemia risk with sulfonylurea already present. ADA/EASD
guidelines recommend SGLT2 inhibitors with proven CVD benefit for patients with T2D
and established ASCVD or high risk.
Q4: A 24-year-old female with type 1 diabetes uses insulin glargine 24 units at bedtime
and insulin lispro with meals (I:C ratio 1:12, correction 1:50). She checks her CGM at 10
PM and reads 142 mg/dL with steady arrow. She plans to sleep at 11 PM. What is the
most appropriate action?
A. Take 2 units lispro correction and recheck in 2 hours
B. Consume 15g fast-acting carbohydrate before bed
C. No action needed; reading is within target range
D. Reduce bedtime glargine by 20% to prevent nocturnal hypoglycemia
Correct Answer: C
Rationale: With a CGM reading of 142 mg/dL and a steady arrow (indicating stable
glucose), no action is needed before sleep. The ADA target for most adults with T1D is
80-180 mg/dL, and 142 mg/dL with stability is optimal for overnight safety. Option A
(correction insulin) is unnecessary as 142 mg/dL is not hyperglycemic requiring
correction, and stacking insulin increases nocturnal hypoglycemia risk. Option B
(carbohydrate) would cause unnecessary hyperglycemia. Option D (reducing basal) is
inappropriate without a pattern of nocturnal hypoglycemia. The patient should verify the
CGM reading with a fingerstick if symptoms exist, but with steady trend and appropriate
bedtime reading, sleep can proceed safely.
