NUR 654 Midterm Exam | Latest Update 2026/2027 | 200
Questions and Verified Answers | Grand Canyon University
Complete Q&A Guide | A+ Graded
1. A patient with type 2 diabetes on metformin and empagliflozin develops euglycemic diabetic
ketoacidosis (euDKA) after starting a ketogenic diet. Which mechanism best explains the euDKA in this
context?
A) Metformininduced lactic acidosis shifting to ketoacidosis
B) Empagliflozin increases glucagon secretion and ketogenesis, while reduced carbohydrate intake
depletes glycogen stores
C) Ketogenic diet directly causes metabolic acidosis independent of SGLT2 inhibition
D) Combined therapy impairs renal ketone excretion leading to accumulation
Answer: B
Rationale: SGLT2 inhibitors like empagliflozin increase glucagon secretion and reduce insulin, promoting
ketogenesis. When carbohydrate intake is severely restricted, glycogen stores are low, leading to euDKA
despite nearnormal glucose levels.
2. A patient presents with rapid weight gain, amenorrhea without pregnancy, and mild hypertension.
Once confirmatory tests are performed, what is a possible treatment for this patient?
A) Thyroid hormone replacement
B) Oral contraceptives
C) Pituitary tumor resection
D) Metformin
Answer: C
Rationale: These symptoms are classic for Cushing's syndrome, often caused by an ACTHsecreting
pituitary adenoma (Cushing's disease). Firstline treatment is transsphenoidal resection of the pituitary
tumor.
,3. A patient has unexplained weight loss and the provider notes increased skin pigmentation on
lightexposed skin folds along with darkened palmar creases. Which laboratory tests should the provider
order?
A) ORDER: Serum ACTH, Serum electrolytes, TB skin testing; NOT: Serum cortisol
B) ORDER: Serum cortisol, Serum ACTH; NOT: Serum electrolytes
C) ORDER: Serum electrolytes, Serum cortisol; NOT: TB skin testing
D) ORDER: TB skin testing, Serum cortisol; NOT: Serum ACTH
Answer: A
Rationale: These findings suggest Addison's disease (primary adrenal insufficiency), characterized by
hyperpigmentation due to elevated ACTH. Diagnosis requires serum ACTH (elevated), electrolytes
(hyponatremia, hyperkalemia), and TB testing to rule out infectious cause.
4. Addison's Disease may cause which of the following lab abnormalities?
A) Hypokalemia
B) Hypernatremia
C) Elevated cortisol
D) Elevated ACTH
Answer: D
Rationale: In primary adrenal insufficiency, the adrenal cortex fails to produce cortisol, leading to loss of
negative feedback on the pituitary and subsequent elevation of ACTH.
,5. Symptoms of Cushing's Syndrome include all of the following EXCEPT:
A) Weight gain
B) Hyperpigmentation
C) Amenorrhea
D) Hypertension
Answer: B
Rationale: Hyperpigmentation is characteristic of Addison's disease, not Cushing's syndrome. Cushing's
syndrome presents with weight gain, amenorrhea, hypertension, moon facies, and striae.
6. A patient with metastatic castrationresistant prostate cancer (mCRPC) is started on abiraterone
acetate plus prednisone. Which laboratory parameter requires the most frequent monitoring due to the
drug's mechanism?
A) Serum creatinine and BUN
B) Serum potassium and blood pressure
C) Liver transaminases and bilirubin
D) Complete blood count with differential
Answer: B
Rationale: Abiraterone inhibits CYP17A1, reducing androgen synthesis but also causing
mineralocorticoid excess, leading to hypertension, hypokalemia, and fluid retention. Prednisone
mitigates these effects but monitoring of potassium and blood pressure is essential.
7. A patient with chronic neuropathic pain from diabetic peripheral neuropathy has inadequate relief
from gabapentin 900 mg/day. Which dose adjustment or adjunct is most appropriate based on current
guidelines?
A) Increase gabapentin to 1800 mg/day in divided doses
, B) Switch to pregabalin 150 mg twice daily
C) Add tramadol 50 mg four times daily
D) Add amitriptyline 25 mg at bedtime
Answer: A
Rationale: Firstline treatment for diabetic peripheral neuropathy includes gabapentinoids. Gabapentin
should be titrated up to 18003600 mg/day (in divided doses) before considering alternatives.
8. Which of the following is an FDAapproved treatment for osteoporosis?
A) Calcium supplementation
B) Vitamin D therapy
C) Bisphosphonate therapy
D) Estrogen therapy
Answer: C
Rationale: Bisphosphonate therapy is FDAapproved for the treatment of osteoporosis. Calcium and
Vitamin D are adjunctive, not primary treatments.
9. True or False: Patient wishes related to palliative care should be discussed at the initial visit and
updated at preventive visits.
A) True
B) False
Answer: A
Rationale: Palliative care discussions should be initiated early and revisited regularly to ensure patient
preferences are documented and respected throughout the disease trajectory.
Questions and Verified Answers | Grand Canyon University
Complete Q&A Guide | A+ Graded
1. A patient with type 2 diabetes on metformin and empagliflozin develops euglycemic diabetic
ketoacidosis (euDKA) after starting a ketogenic diet. Which mechanism best explains the euDKA in this
context?
A) Metformininduced lactic acidosis shifting to ketoacidosis
B) Empagliflozin increases glucagon secretion and ketogenesis, while reduced carbohydrate intake
depletes glycogen stores
C) Ketogenic diet directly causes metabolic acidosis independent of SGLT2 inhibition
D) Combined therapy impairs renal ketone excretion leading to accumulation
Answer: B
Rationale: SGLT2 inhibitors like empagliflozin increase glucagon secretion and reduce insulin, promoting
ketogenesis. When carbohydrate intake is severely restricted, glycogen stores are low, leading to euDKA
despite nearnormal glucose levels.
2. A patient presents with rapid weight gain, amenorrhea without pregnancy, and mild hypertension.
Once confirmatory tests are performed, what is a possible treatment for this patient?
A) Thyroid hormone replacement
B) Oral contraceptives
C) Pituitary tumor resection
D) Metformin
Answer: C
Rationale: These symptoms are classic for Cushing's syndrome, often caused by an ACTHsecreting
pituitary adenoma (Cushing's disease). Firstline treatment is transsphenoidal resection of the pituitary
tumor.
,3. A patient has unexplained weight loss and the provider notes increased skin pigmentation on
lightexposed skin folds along with darkened palmar creases. Which laboratory tests should the provider
order?
A) ORDER: Serum ACTH, Serum electrolytes, TB skin testing; NOT: Serum cortisol
B) ORDER: Serum cortisol, Serum ACTH; NOT: Serum electrolytes
C) ORDER: Serum electrolytes, Serum cortisol; NOT: TB skin testing
D) ORDER: TB skin testing, Serum cortisol; NOT: Serum ACTH
Answer: A
Rationale: These findings suggest Addison's disease (primary adrenal insufficiency), characterized by
hyperpigmentation due to elevated ACTH. Diagnosis requires serum ACTH (elevated), electrolytes
(hyponatremia, hyperkalemia), and TB testing to rule out infectious cause.
4. Addison's Disease may cause which of the following lab abnormalities?
A) Hypokalemia
B) Hypernatremia
C) Elevated cortisol
D) Elevated ACTH
Answer: D
Rationale: In primary adrenal insufficiency, the adrenal cortex fails to produce cortisol, leading to loss of
negative feedback on the pituitary and subsequent elevation of ACTH.
,5. Symptoms of Cushing's Syndrome include all of the following EXCEPT:
A) Weight gain
B) Hyperpigmentation
C) Amenorrhea
D) Hypertension
Answer: B
Rationale: Hyperpigmentation is characteristic of Addison's disease, not Cushing's syndrome. Cushing's
syndrome presents with weight gain, amenorrhea, hypertension, moon facies, and striae.
6. A patient with metastatic castrationresistant prostate cancer (mCRPC) is started on abiraterone
acetate plus prednisone. Which laboratory parameter requires the most frequent monitoring due to the
drug's mechanism?
A) Serum creatinine and BUN
B) Serum potassium and blood pressure
C) Liver transaminases and bilirubin
D) Complete blood count with differential
Answer: B
Rationale: Abiraterone inhibits CYP17A1, reducing androgen synthesis but also causing
mineralocorticoid excess, leading to hypertension, hypokalemia, and fluid retention. Prednisone
mitigates these effects but monitoring of potassium and blood pressure is essential.
7. A patient with chronic neuropathic pain from diabetic peripheral neuropathy has inadequate relief
from gabapentin 900 mg/day. Which dose adjustment or adjunct is most appropriate based on current
guidelines?
A) Increase gabapentin to 1800 mg/day in divided doses
, B) Switch to pregabalin 150 mg twice daily
C) Add tramadol 50 mg four times daily
D) Add amitriptyline 25 mg at bedtime
Answer: A
Rationale: Firstline treatment for diabetic peripheral neuropathy includes gabapentinoids. Gabapentin
should be titrated up to 18003600 mg/day (in divided doses) before considering alternatives.
8. Which of the following is an FDAapproved treatment for osteoporosis?
A) Calcium supplementation
B) Vitamin D therapy
C) Bisphosphonate therapy
D) Estrogen therapy
Answer: C
Rationale: Bisphosphonate therapy is FDAapproved for the treatment of osteoporosis. Calcium and
Vitamin D are adjunctive, not primary treatments.
9. True or False: Patient wishes related to palliative care should be discussed at the initial visit and
updated at preventive visits.
A) True
B) False
Answer: A
Rationale: Palliative care discussions should be initiated early and revisited regularly to ensure patient
preferences are documented and respected throughout the disease trajectory.
