ATI MED-SURG ENDOCRINE EXAM
Test Bank: Questions with Answers & Rationales
2025/2026 Edition
SECTION 1: Diabetes Mellitus – Type 1 & Type 2 (Questions 1-60)
Standard Multiple Choice
1. A nurse is teaching a client with type 1 diabetes about the proper technique for
injecting insulin. Which statement by the client indicates an understanding of the
teaching?
A) "I will inject insulin into my abdomen for the fastest absorption."
B) "I should always use the same spot to ensure consistent absorption."
C) "I can inject insulin through my clothing if I'm in a hurry."
D) "I need to massage the site after injection to distribute the insulin."
Answer: A) "I will inject insulin into my abdomen for the fastest absorption."
Rationale: The abdomen provides the most rapid and consistent absorption of insulin due to
its vascularity and relatively consistent subcutaneous tissue thickness. Rotation within one
anatomic region (e.g., abdomen) is recommended, not using the exact same spot each time,
as this causes lipohypertrophy. Injecting through clothing introduces bacteria and risks
inaccurate dosing. Massaging the site is not recommended as it can alter absorption rates .
2. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which arterial blood gas
(ABG) finding is expected?
A) pH 7.48, PaCO2 48 mm Hg, HCO3 30 mEq/L
B) pH 7.35, PaCO2 40 mm Hg, HCO3 24 mEq/L
C) pH 7.30, PaCO2 30 mm Hg, HCO3 16 mEq/L
D) pH 7.50, PaCO2 35 mm Hg, HCO3 28 mEq/L
Answer: C) pH 7.30, PaCO2 30 mm Hg, HCO3 16 mEq/L
Rationale: DKA is characterized by metabolic acidosis (low pH, low HCO3) with
compensatory respiratory alkalosis (low PaCO2 due to Kussmaul respirations). Option C
shows metabolic acidosis (pH 7.30, HCO3 16) with appropriate respiratory compensation
(PaCO2 30). Option A indicates metabolic alkalosis, Option B shows normal values, and
Option D indicates metabolic alkalosis with respiratory compensation .
,3. A nurse is monitoring a client receiving an insulin infusion for DKA. Which laboratory
value requires immediate intervention?
A) Blood glucose 180 mg/dL
B) Serum potassium 2.8 mEq/L
C) Serum sodium 135 mEq/L
D) Blood glucose 250 mg/dL
Answer: B) Serum potassium 2.8 mEq/L
Rationale: Hypokalemia (potassium <3.5 mEq/L) is a life-threatening complication during
DKA treatment because insulin drives potassium into cells, potentially causing cardiac
dysrhythmias. A potassium level of 2.8 mEq/L requires immediate potassium replacement
and cardiac monitoring. Blood glucose levels of 180-250 mg/dL are expected during
treatment as glucose gradually decreases .
4. A client with type 2 diabetes has a blood glucose level of 55 mg/dL and is conscious.
What should the nurse administer first?
A) 1 mg glucagon intramuscularly
B) 4 oz (120 mL) of orange juice
C) 10 units of regular insulin IV push
D) 50 mL of 50% dextrose IV push
Answer: B) 4 oz (120 mL) of orange juice
Rationale: For a conscious client with hypoglycemia (<70 mg/dL), the priority is
administration of 15 grams of fast-acting carbohydrate. Orange juice provides rapid glucose
absorption. Glucagon is reserved for unconscious clients. Insulin would worsen
hypoglycemia. IV dextrose is indicated for unconscious clients or those unable to swallow .
5. A nurse is teaching a client with type 1 diabetes about "sick day rules." Which
statement indicates understanding?
A) "I will stop my insulin when I cannot eat."
B) "I will check my blood glucose every 4 hours while sick."
C) "I will contact my provider if my blood glucose is over 200 mg/dL."
D) "I will avoid eating carbohydrates until I feel better."
Answer: B) "I will check my blood glucose every 4 hours while sick."
Rationale: During illness, blood glucose should be checked at least every 4 hours due to
increased insulin resistance from stress hormones. Insulin should never be stopped during
illness, as this can precipitate DKA. Clients should contact the provider for blood glucose
>250 mg/dL, not 200. Carbohydrates should be consumed to provide energy and prevent
starvation ketosis .
,6. A client with type 2 diabetes is prescribed metformin. Which statement by the client
requires further teaching?
A) "I should take this medication with meals to prevent stomach upset."
B) "I need to stop this medication before my CT scan with contrast dye."
C) "This medication can cause weight gain."
D) "I will report any unusual muscle pain to my provider."
Answer: C) "This medication can cause weight gain."
Rationale: Metformin is associated with weight neutrality or modest weight loss, not weight
gain. Weight gain is more commonly associated with sulfonylureas and insulin. Taking
metformin with meals reduces gastrointestinal side effects. Metformin should be held before
contrast procedures to prevent lactic acidosis. Muscle pain may indicate lactic acidosis and
should be reported .
7. A nurse is assessing a client with hyperosmolar hyperglycemic state (HHS). Which
finding is expected?
A) Kussmaul respirations
B) Serum pH 7.32
C) Serum ketones negative
D) Fruity breath odor
Answer: C) Serum ketones negative
Rationale: HHS is characterized by severe hyperglycemia (>600 mg/dL) with minimal or
absent ketones because there is sufficient insulin to prevent lipolysis and ketogenesis.
Kussmaul respirations, low pH, and fruity breath are characteristic of DKA, not HHS .
8. A nurse is preparing to administer regular insulin IV continuous infusion. Which action is
essential?
A) Shake the vial vigorously before drawing up insulin
B) Use an insulin syringe marked in units for IV administration
C) Administer through tubing with an in-line filter
D) Flush the IV tubing with insulin before connecting to the client
Answer: C) Administer through tubing with an in-line filter
Rationale: Regular insulin can be given IV, but it adsorbs to plastic IV tubing. An in-line filter
or "priming" the tubing with insulin solution helps ensure accurate dosing. Insulin vials
should be rolled, not shaken, to avoid bubbles. Insulin syringes are for subcutaneous
administration. Flushing tubing with insulin alone would waste medication and cause
inaccurate dosing .
, 9. A client with diabetes reports a "pins and needles" sensation in both feet. The nurse
recognizes this as which complication?
A) Peripheral arterial disease
B) Autonomic neuropathy
C) Peripheral sensory neuropathy
D) Charcot foot
Answer: C) Peripheral sensory neuropathy
Rationale: Peripheral sensory neuropathy is the most common diabetic neuropathy,
presenting with paresthesias (tingling, burning, "pins and needles"), numbness, and loss of
protective sensation. Autonomic neuropathy affects GI motility, bladder function, and
cardiovascular responses. Peripheral arterial disease presents with claudication and
diminished pulses. Charcot foot involves joint destruction .
10. A nurse is teaching foot care to a client with diabetes and peripheral neuropathy.
Which statement indicates understanding?
A) "I will soak my feet daily in warm water to soften calluses."
B) "I will use a heating pad on cold nights to warm my feet."
C) "I will apply lotion to my feet but not between my toes."
D) "I will trim my toenails rounded at the edges."
Answer: C) "I will apply lotion to my feet but not between my toes."
Rationale: Lotion prevents dry, cracked skin but should not be applied between the toes
because moisture promotes fungal growth. Soaking feet and heating pads increase injury
risk due to loss of protective sensation. Toenails should be trimmed straight across to
prevent ingrown toenails .
11. A nurse is caring for a client with DKA who has an initial potassium level of 5.8 mEq/L.
Which action is appropriate?
A) Administer potassium replacement immediately
B) Withhold potassium replacement until urine output is established
C) Delay potassium replacement until blood glucose is <200 mg/dL
D) Hold potassium replacement and recheck in 4 hours
Answer: B) Withhold potassium replacement until urine output is established
Rationale: Initial hyperkalemia in DKA is caused by acidosis pushing potassium out of cells.
Once insulin therapy begins, potassium shifts back into cells, and hypokalemia can develop
rapidly. However, potassium replacement should not be initiated until adequate renal
function (urine output >30 mL/hr) is confirmed to prevent hyperkalemia from replacement .
Test Bank: Questions with Answers & Rationales
2025/2026 Edition
SECTION 1: Diabetes Mellitus – Type 1 & Type 2 (Questions 1-60)
Standard Multiple Choice
1. A nurse is teaching a client with type 1 diabetes about the proper technique for
injecting insulin. Which statement by the client indicates an understanding of the
teaching?
A) "I will inject insulin into my abdomen for the fastest absorption."
B) "I should always use the same spot to ensure consistent absorption."
C) "I can inject insulin through my clothing if I'm in a hurry."
D) "I need to massage the site after injection to distribute the insulin."
Answer: A) "I will inject insulin into my abdomen for the fastest absorption."
Rationale: The abdomen provides the most rapid and consistent absorption of insulin due to
its vascularity and relatively consistent subcutaneous tissue thickness. Rotation within one
anatomic region (e.g., abdomen) is recommended, not using the exact same spot each time,
as this causes lipohypertrophy. Injecting through clothing introduces bacteria and risks
inaccurate dosing. Massaging the site is not recommended as it can alter absorption rates .
2. A nurse is caring for a client with diabetic ketoacidosis (DKA). Which arterial blood gas
(ABG) finding is expected?
A) pH 7.48, PaCO2 48 mm Hg, HCO3 30 mEq/L
B) pH 7.35, PaCO2 40 mm Hg, HCO3 24 mEq/L
C) pH 7.30, PaCO2 30 mm Hg, HCO3 16 mEq/L
D) pH 7.50, PaCO2 35 mm Hg, HCO3 28 mEq/L
Answer: C) pH 7.30, PaCO2 30 mm Hg, HCO3 16 mEq/L
Rationale: DKA is characterized by metabolic acidosis (low pH, low HCO3) with
compensatory respiratory alkalosis (low PaCO2 due to Kussmaul respirations). Option C
shows metabolic acidosis (pH 7.30, HCO3 16) with appropriate respiratory compensation
(PaCO2 30). Option A indicates metabolic alkalosis, Option B shows normal values, and
Option D indicates metabolic alkalosis with respiratory compensation .
,3. A nurse is monitoring a client receiving an insulin infusion for DKA. Which laboratory
value requires immediate intervention?
A) Blood glucose 180 mg/dL
B) Serum potassium 2.8 mEq/L
C) Serum sodium 135 mEq/L
D) Blood glucose 250 mg/dL
Answer: B) Serum potassium 2.8 mEq/L
Rationale: Hypokalemia (potassium <3.5 mEq/L) is a life-threatening complication during
DKA treatment because insulin drives potassium into cells, potentially causing cardiac
dysrhythmias. A potassium level of 2.8 mEq/L requires immediate potassium replacement
and cardiac monitoring. Blood glucose levels of 180-250 mg/dL are expected during
treatment as glucose gradually decreases .
4. A client with type 2 diabetes has a blood glucose level of 55 mg/dL and is conscious.
What should the nurse administer first?
A) 1 mg glucagon intramuscularly
B) 4 oz (120 mL) of orange juice
C) 10 units of regular insulin IV push
D) 50 mL of 50% dextrose IV push
Answer: B) 4 oz (120 mL) of orange juice
Rationale: For a conscious client with hypoglycemia (<70 mg/dL), the priority is
administration of 15 grams of fast-acting carbohydrate. Orange juice provides rapid glucose
absorption. Glucagon is reserved for unconscious clients. Insulin would worsen
hypoglycemia. IV dextrose is indicated for unconscious clients or those unable to swallow .
5. A nurse is teaching a client with type 1 diabetes about "sick day rules." Which
statement indicates understanding?
A) "I will stop my insulin when I cannot eat."
B) "I will check my blood glucose every 4 hours while sick."
C) "I will contact my provider if my blood glucose is over 200 mg/dL."
D) "I will avoid eating carbohydrates until I feel better."
Answer: B) "I will check my blood glucose every 4 hours while sick."
Rationale: During illness, blood glucose should be checked at least every 4 hours due to
increased insulin resistance from stress hormones. Insulin should never be stopped during
illness, as this can precipitate DKA. Clients should contact the provider for blood glucose
>250 mg/dL, not 200. Carbohydrates should be consumed to provide energy and prevent
starvation ketosis .
,6. A client with type 2 diabetes is prescribed metformin. Which statement by the client
requires further teaching?
A) "I should take this medication with meals to prevent stomach upset."
B) "I need to stop this medication before my CT scan with contrast dye."
C) "This medication can cause weight gain."
D) "I will report any unusual muscle pain to my provider."
Answer: C) "This medication can cause weight gain."
Rationale: Metformin is associated with weight neutrality or modest weight loss, not weight
gain. Weight gain is more commonly associated with sulfonylureas and insulin. Taking
metformin with meals reduces gastrointestinal side effects. Metformin should be held before
contrast procedures to prevent lactic acidosis. Muscle pain may indicate lactic acidosis and
should be reported .
7. A nurse is assessing a client with hyperosmolar hyperglycemic state (HHS). Which
finding is expected?
A) Kussmaul respirations
B) Serum pH 7.32
C) Serum ketones negative
D) Fruity breath odor
Answer: C) Serum ketones negative
Rationale: HHS is characterized by severe hyperglycemia (>600 mg/dL) with minimal or
absent ketones because there is sufficient insulin to prevent lipolysis and ketogenesis.
Kussmaul respirations, low pH, and fruity breath are characteristic of DKA, not HHS .
8. A nurse is preparing to administer regular insulin IV continuous infusion. Which action is
essential?
A) Shake the vial vigorously before drawing up insulin
B) Use an insulin syringe marked in units for IV administration
C) Administer through tubing with an in-line filter
D) Flush the IV tubing with insulin before connecting to the client
Answer: C) Administer through tubing with an in-line filter
Rationale: Regular insulin can be given IV, but it adsorbs to plastic IV tubing. An in-line filter
or "priming" the tubing with insulin solution helps ensure accurate dosing. Insulin vials
should be rolled, not shaken, to avoid bubbles. Insulin syringes are for subcutaneous
administration. Flushing tubing with insulin alone would waste medication and cause
inaccurate dosing .
, 9. A client with diabetes reports a "pins and needles" sensation in both feet. The nurse
recognizes this as which complication?
A) Peripheral arterial disease
B) Autonomic neuropathy
C) Peripheral sensory neuropathy
D) Charcot foot
Answer: C) Peripheral sensory neuropathy
Rationale: Peripheral sensory neuropathy is the most common diabetic neuropathy,
presenting with paresthesias (tingling, burning, "pins and needles"), numbness, and loss of
protective sensation. Autonomic neuropathy affects GI motility, bladder function, and
cardiovascular responses. Peripheral arterial disease presents with claudication and
diminished pulses. Charcot foot involves joint destruction .
10. A nurse is teaching foot care to a client with diabetes and peripheral neuropathy.
Which statement indicates understanding?
A) "I will soak my feet daily in warm water to soften calluses."
B) "I will use a heating pad on cold nights to warm my feet."
C) "I will apply lotion to my feet but not between my toes."
D) "I will trim my toenails rounded at the edges."
Answer: C) "I will apply lotion to my feet but not between my toes."
Rationale: Lotion prevents dry, cracked skin but should not be applied between the toes
because moisture promotes fungal growth. Soaking feet and heating pads increase injury
risk due to loss of protective sensation. Toenails should be trimmed straight across to
prevent ingrown toenails .
11. A nurse is caring for a client with DKA who has an initial potassium level of 5.8 mEq/L.
Which action is appropriate?
A) Administer potassium replacement immediately
B) Withhold potassium replacement until urine output is established
C) Delay potassium replacement until blood glucose is <200 mg/dL
D) Hold potassium replacement and recheck in 4 hours
Answer: B) Withhold potassium replacement until urine output is established
Rationale: Initial hyperkalemia in DKA is caused by acidosis pushing potassium out of cells.
Once insulin therapy begins, potassium shifts back into cells, and hypokalemia can develop
rapidly. However, potassium replacement should not be initiated until adequate renal
function (urine output >30 mL/hr) is confirmed to prevent hyperkalemia from replacement .
