NUR 265 – EXAM 4 | Questions and Answers |
2026 Update | 100% Correct – Galen
SECTION 1: ENDOCRINE DISORDERS (12 Questions)
Q1: A client with Type 1 diabetes mellitus presents with blood glucose 320 mg/dL, pH
7.28, HCO3 12 mEq/L, and positive serum ketones. Which intervention is the priority?
A. Initiate an IV insulin drip at 0.1 units/kg/hr after fluid resuscitation
B. Administer subcutaneous rapid-acting insulin immediately
C. Begin oral hydration with glucose-containing fluids
D. Start potassium replacement at 40 mEq/hr IV without checking current level
Correct Answer: A
Rationale: Correct because this client has DKA; per 2026 clinical guidelines, fluid
resuscitation with 0.9% NS is initiated first, followed by a regular insulin IV drip at 0.1
units/kg/hr. Subcutaneous insulin is contraindicated in DKA due to poor absorption from
dehydration.
Q2: A nurse is teaching a client newly diagnosed with Type 2 diabetes mellitus about
first-line pharmacologic therapy. Which statement by the client indicates understanding?
A. "I will start with insulin injections right away."
B. "Metformin is the preferred initial medication for most adults with Type 2 diabetes."
C. "I should avoid all oral medications and use only diet and exercise."
D. "Sulfonylureas are the safest option for patients with heart disease."
Correct Answer: B
Rationale: Correct because per 2026 ADA guidelines, metformin remains first-line
pharmacologic therapy for Type 2 diabetes unless contraindicated. GLP-1 receptor
agonists and SGLT2 inhibitors are added for cardiovascular protection in patients with
established ASCVD or high CV risk.
Q3: A client with Type 1 diabetes asks why they need insulin while their sibling with Type
2 diabetes does not. Which response by the nurse is most accurate?
,A. "Type 1 diabetes results from autoimmune destruction of pancreatic beta cells
causing absolute insulin deficiency, requiring exogenous insulin for survival."
B. "Type 1 diabetes is caused by eating too much sugar, while Type 2 is genetic."
C. "Type 1 diabetes is less serious than Type 2, so insulin is optional."
D. "Type 1 diabetes only affects children, while Type 2 affects adults."
Correct Answer: A
Rationale: Correct because Type 1 diabetes is characterized by autoimmune-mediated
destruction of pancreatic beta cells resulting in absolute insulin deficiency, necessitating
lifelong exogenous insulin replacement. Type 2 diabetes involves insulin resistance with
relative insulin deficiency.
Q4: A client with DKA has a serum potassium level of 4.8 mEq/L after initial fluid
resuscitation. Which action should the nurse take?
A. Withhold potassium replacement until the level exceeds 5.5 mEq/L
B. Add potassium to IV fluids at 20-30 mEq/L if urine output is adequate
C. Administer a potassium bolus of 40 mEq over 5 minutes
D. Discontinue insulin until potassium normalizes
Correct Answer: B
Rationale: Correct because per standard of care, potassium replacement is initiated
when serum K+ falls below 5.3 mEq/L and urine output is adequate. Insulin drives
potassium intracellularly, so replacement prevents life-threatening hypokalemia during
DKA treatment.
Q5: A 68-year-old client is admitted with blood glucose 780 mg/dL, serum osmolality 340
mOsm/kg, and no significant ketones. The client is profoundly dehydrated. Which is the
priority nursing intervention?
A. Begin rapid insulin infusion at 0.14 units/kg/hr immediately
B. Initiate aggressive IV fluid replacement with 0.9% NS at 1-1.5 L in the first hour
C. Administer oral hypotonic fluids to replace losses
D. Start mannitol for suspected cerebral edema prophylaxis
Correct Answer: B
Rationale: Correct because this client has HHS; fluid replacement is the priority
intervention before insulin administration. Slow rehydration is essential to prevent
osmotic demyelination syndrome. Insulin is initiated only after adequate fluid
resuscitation has begun.
, Q6: A client with hyperthyroidism develops a temperature of 103°F, heart rate 160 bpm,
and altered mental status. Which medication should the nurse prepare to administer
first?
A. Propylthiouracil (PTU) 600 mg via nasogastric tube
B. Propranolol 60-80 mg orally every 4 hours
C. Methimazole 20 mg orally every 6 hours
D. Hydrocortisone 300 mg IV push
Correct Answer: B
Rationale: Correct because this client is in thyroid storm; beta-blockers (propranolol
preferred) are administered first to control tachycardia and block peripheral conversion
of T4 to T3. PTU or methimazole and supportive measures follow.
Q7: A client with myxedema coma presents with a core temperature of 92°F, heart rate 48
bpm, and blood pressure 78/50 mmHg. Which medication should the nurse anticipate
administering?
A. Levothyroxine IV loading dose of 200-400 mcg followed by 100 mcg daily
B. Methimazole 20 mg orally
C. Propylthiouracil 600 mg loading dose
D. Regular insulin 10 units IV push
Correct Answer: A
Rationale: Correct because myxedema coma is treated with IV levothyroxine loading
dose of 200-400 mcg, followed by 100 mcg daily. Hydrocortisone is also administered
due to possible concurrent adrenal insufficiency until adrenal function is confirmed.
Q8: A client in Addisonian crisis presents with hypotension unresponsive to fluids, blood
glucose 48 mg/dL, sodium 128 mEq/L, and potassium 6.2 mEq/L. Which intervention is
the priority?
A. Administer stress-dose hydrocortisone 100 mg IV push, then 200 mg over 24 hours
B. Begin aggressive potassium replacement immediately
C. Administer rapid-acting insulin to correct hyperkalemia
D. Infuse 3% hypertonic saline to correct hyponatremia rapidly
Correct Answer: A
2026 Update | 100% Correct – Galen
SECTION 1: ENDOCRINE DISORDERS (12 Questions)
Q1: A client with Type 1 diabetes mellitus presents with blood glucose 320 mg/dL, pH
7.28, HCO3 12 mEq/L, and positive serum ketones. Which intervention is the priority?
A. Initiate an IV insulin drip at 0.1 units/kg/hr after fluid resuscitation
B. Administer subcutaneous rapid-acting insulin immediately
C. Begin oral hydration with glucose-containing fluids
D. Start potassium replacement at 40 mEq/hr IV without checking current level
Correct Answer: A
Rationale: Correct because this client has DKA; per 2026 clinical guidelines, fluid
resuscitation with 0.9% NS is initiated first, followed by a regular insulin IV drip at 0.1
units/kg/hr. Subcutaneous insulin is contraindicated in DKA due to poor absorption from
dehydration.
Q2: A nurse is teaching a client newly diagnosed with Type 2 diabetes mellitus about
first-line pharmacologic therapy. Which statement by the client indicates understanding?
A. "I will start with insulin injections right away."
B. "Metformin is the preferred initial medication for most adults with Type 2 diabetes."
C. "I should avoid all oral medications and use only diet and exercise."
D. "Sulfonylureas are the safest option for patients with heart disease."
Correct Answer: B
Rationale: Correct because per 2026 ADA guidelines, metformin remains first-line
pharmacologic therapy for Type 2 diabetes unless contraindicated. GLP-1 receptor
agonists and SGLT2 inhibitors are added for cardiovascular protection in patients with
established ASCVD or high CV risk.
Q3: A client with Type 1 diabetes asks why they need insulin while their sibling with Type
2 diabetes does not. Which response by the nurse is most accurate?
,A. "Type 1 diabetes results from autoimmune destruction of pancreatic beta cells
causing absolute insulin deficiency, requiring exogenous insulin for survival."
B. "Type 1 diabetes is caused by eating too much sugar, while Type 2 is genetic."
C. "Type 1 diabetes is less serious than Type 2, so insulin is optional."
D. "Type 1 diabetes only affects children, while Type 2 affects adults."
Correct Answer: A
Rationale: Correct because Type 1 diabetes is characterized by autoimmune-mediated
destruction of pancreatic beta cells resulting in absolute insulin deficiency, necessitating
lifelong exogenous insulin replacement. Type 2 diabetes involves insulin resistance with
relative insulin deficiency.
Q4: A client with DKA has a serum potassium level of 4.8 mEq/L after initial fluid
resuscitation. Which action should the nurse take?
A. Withhold potassium replacement until the level exceeds 5.5 mEq/L
B. Add potassium to IV fluids at 20-30 mEq/L if urine output is adequate
C. Administer a potassium bolus of 40 mEq over 5 minutes
D. Discontinue insulin until potassium normalizes
Correct Answer: B
Rationale: Correct because per standard of care, potassium replacement is initiated
when serum K+ falls below 5.3 mEq/L and urine output is adequate. Insulin drives
potassium intracellularly, so replacement prevents life-threatening hypokalemia during
DKA treatment.
Q5: A 68-year-old client is admitted with blood glucose 780 mg/dL, serum osmolality 340
mOsm/kg, and no significant ketones. The client is profoundly dehydrated. Which is the
priority nursing intervention?
A. Begin rapid insulin infusion at 0.14 units/kg/hr immediately
B. Initiate aggressive IV fluid replacement with 0.9% NS at 1-1.5 L in the first hour
C. Administer oral hypotonic fluids to replace losses
D. Start mannitol for suspected cerebral edema prophylaxis
Correct Answer: B
Rationale: Correct because this client has HHS; fluid replacement is the priority
intervention before insulin administration. Slow rehydration is essential to prevent
osmotic demyelination syndrome. Insulin is initiated only after adequate fluid
resuscitation has begun.
, Q6: A client with hyperthyroidism develops a temperature of 103°F, heart rate 160 bpm,
and altered mental status. Which medication should the nurse prepare to administer
first?
A. Propylthiouracil (PTU) 600 mg via nasogastric tube
B. Propranolol 60-80 mg orally every 4 hours
C. Methimazole 20 mg orally every 6 hours
D. Hydrocortisone 300 mg IV push
Correct Answer: B
Rationale: Correct because this client is in thyroid storm; beta-blockers (propranolol
preferred) are administered first to control tachycardia and block peripheral conversion
of T4 to T3. PTU or methimazole and supportive measures follow.
Q7: A client with myxedema coma presents with a core temperature of 92°F, heart rate 48
bpm, and blood pressure 78/50 mmHg. Which medication should the nurse anticipate
administering?
A. Levothyroxine IV loading dose of 200-400 mcg followed by 100 mcg daily
B. Methimazole 20 mg orally
C. Propylthiouracil 600 mg loading dose
D. Regular insulin 10 units IV push
Correct Answer: A
Rationale: Correct because myxedema coma is treated with IV levothyroxine loading
dose of 200-400 mcg, followed by 100 mcg daily. Hydrocortisone is also administered
due to possible concurrent adrenal insufficiency until adrenal function is confirmed.
Q8: A client in Addisonian crisis presents with hypotension unresponsive to fluids, blood
glucose 48 mg/dL, sodium 128 mEq/L, and potassium 6.2 mEq/L. Which intervention is
the priority?
A. Administer stress-dose hydrocortisone 100 mg IV push, then 200 mg over 24 hours
B. Begin aggressive potassium replacement immediately
C. Administer rapid-acting insulin to correct hyperkalemia
D. Infuse 3% hypertonic saline to correct hyponatremia rapidly
Correct Answer: A
