NUR 445 EXAM 1 LATEST
QUESTIONS AND
ANSWERS 2026 - 2027
What is an anion gap?
- measures the difference between the negatively charged and positively
charged electrolytes in your blood
- high gap = acidosis
- low gap = alkalosis
What patient education should be provided for preventing DKA?
Sick day care: check BG often (q4hr), continue using insulin when not
eating if BG indicates, drink water, check urine for ketones if BG is
above 230, go to Dr if ketonuria positive, adjust insulin for vomiting
based on BG levels and encourage gatorade (fluid+ electrolytes+
glucose)
What are the pathophysiology differences between DKA and HHS?
DKA:
- Hyperglycemia with not enough insulin being produced or
administered to use the glucose in the blood, which results in fat
breakdown for energy. Ketones are an acid that are produced as a bi-
product of fat breakdown, resulting in a state of metabolic acidosis.
HHS:
- Hyperglycemia, often as a result from illness or other bodily stress,
with enough insulin production by the body to prevent the need for fat to
be broken down. High amounts of glucose in the blood result in
END OF
PAGE
1
, NUR 445 EXAM 1 LATEST
QUESTIONS AND
ANSWERS 2026 - 2027
hyperosmolarity which increases diuresis, decreasing the amount of acid
in the body (pee out acid), resulting in state of a metabolic alkalosis with
profound dehydration.
How is HHS Dx?
BG > 600
Serum osmolality > 320
PROFOUND DEHYDRATION
Alkalosis (pH > 7.4 and Bicarb > 15)
ketones may be present in the urine but in very low amounts
Altered LOC
What are the diagnostic differences between DKA and HHS?
DKA:
- acute, BG >250, low serum osmo, low bicarb, low pH, serum and urine
ketones, positive anion gap, treated with insulin, fluids, and electrolytes
HHS:
- gradual, BG >600, high serum osmo (>320), high bicarb, high pH, low
or no serum/urine ketones, variable anion gap, decreased GFR +
profound dehydration, treated with fluids, electrolyte correction, and
airway management
What are the s/s of HHS?
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PAGE
2
, NUR 445 EXAM 1 LATEST
QUESTIONS AND
ANSWERS 2026 - 2027
three Ps: polydipsia, polyurea, polyphasia
normal HHS blood sugar: 600-1200 (higher than DKA)
tongue looks like shoe leather
tenting of tissues
tachycardia
hypotensive
rapid and shallow RRs
What are the Early s/s of death?
social withdrawal
anorexia and adipsia
possible increased sleep
What are the Middle s/s of death?
declining mental status (confusion and disorientation)
increase in sleep
hypothermia and hypotension
irregular pulse
labored and fast respirations
pallor
What are the Late s/s of death?
brief surge of energy
coma
skin cold an mottling
END OF
PAGE
3
QUESTIONS AND
ANSWERS 2026 - 2027
What is an anion gap?
- measures the difference between the negatively charged and positively
charged electrolytes in your blood
- high gap = acidosis
- low gap = alkalosis
What patient education should be provided for preventing DKA?
Sick day care: check BG often (q4hr), continue using insulin when not
eating if BG indicates, drink water, check urine for ketones if BG is
above 230, go to Dr if ketonuria positive, adjust insulin for vomiting
based on BG levels and encourage gatorade (fluid+ electrolytes+
glucose)
What are the pathophysiology differences between DKA and HHS?
DKA:
- Hyperglycemia with not enough insulin being produced or
administered to use the glucose in the blood, which results in fat
breakdown for energy. Ketones are an acid that are produced as a bi-
product of fat breakdown, resulting in a state of metabolic acidosis.
HHS:
- Hyperglycemia, often as a result from illness or other bodily stress,
with enough insulin production by the body to prevent the need for fat to
be broken down. High amounts of glucose in the blood result in
END OF
PAGE
1
, NUR 445 EXAM 1 LATEST
QUESTIONS AND
ANSWERS 2026 - 2027
hyperosmolarity which increases diuresis, decreasing the amount of acid
in the body (pee out acid), resulting in state of a metabolic alkalosis with
profound dehydration.
How is HHS Dx?
BG > 600
Serum osmolality > 320
PROFOUND DEHYDRATION
Alkalosis (pH > 7.4 and Bicarb > 15)
ketones may be present in the urine but in very low amounts
Altered LOC
What are the diagnostic differences between DKA and HHS?
DKA:
- acute, BG >250, low serum osmo, low bicarb, low pH, serum and urine
ketones, positive anion gap, treated with insulin, fluids, and electrolytes
HHS:
- gradual, BG >600, high serum osmo (>320), high bicarb, high pH, low
or no serum/urine ketones, variable anion gap, decreased GFR +
profound dehydration, treated with fluids, electrolyte correction, and
airway management
What are the s/s of HHS?
END OF
PAGE
2
, NUR 445 EXAM 1 LATEST
QUESTIONS AND
ANSWERS 2026 - 2027
three Ps: polydipsia, polyurea, polyphasia
normal HHS blood sugar: 600-1200 (higher than DKA)
tongue looks like shoe leather
tenting of tissues
tachycardia
hypotensive
rapid and shallow RRs
What are the Early s/s of death?
social withdrawal
anorexia and adipsia
possible increased sleep
What are the Middle s/s of death?
declining mental status (confusion and disorientation)
increase in sleep
hypothermia and hypotension
irregular pulse
labored and fast respirations
pallor
What are the Late s/s of death?
brief surge of energy
coma
skin cold an mottling
END OF
PAGE
3
