NUR 172 SKYLER HANSEN VSIM | 2026/2027 EDITION|
VERIFIED ANSWERS .
DOMAIN 1: HYPOGLYCEMIA RECOGNITION & EMERGENCY MANAGEMENT (Questions 1-6)
Q1. A nurse is assessing Skyler Hansen upon arrival to the emergency department. Which of
the following findings are consistent with hypoglycemia? (Select all that apply)
A. Blood glucose 48 mg/dL [CORRECT]
B. Cool and clammy skin [CORRECT]
C. Fruity breath odor
D. Tachycardia [CORRECT]
E. Kussmaul respirations
F. Altered mental status [CORRECT]
Correct Answers: A, B, D, F
Rationale: Hypoglycemia (BG 48 mg/dL) manifests with adrenergic symptoms (tachycardia,
cool/clammy skin, diaphoresis) and neuroglycopenic symptoms (altered mental status). Fruity
breath and Kussmaul respirations indicate diabetic ketoacidosis, not hypoglycemia.
Q2. Skyler Hansen is unresponsive with a blood glucose of 48 mg/dL. IV access is established.
What is the priority nursing action?
A. Administer glucagon 1 mg IM
B. Administer D50 IV push per order [CORRECT]
C. Obtain a full set of vital signs
D. Notify the healthcare provider
Correct Answer: B
Rationale: For an unresponsive hypoglycemic patient with IV access, D50 IV push is the
priority intervention to rapidly restore blood glucose and prevent neurologic injury. Vital signs
and provider notification occur after or concurrent with treatment initiation. Glucagon is used
when IV access is unavailable.
, Q3. After administering D50, when should the nurse reassess Skyler Hansen's blood glucose?
A. 5 minutes after administration
B. 15 minutes after administration [CORRECT]
C. 30 minutes after administration
D. 60 minutes after administration
Correct Answer: B
Rationale: The "Rule of 15" applies: reassess blood glucose 15 minutes after treating
hypoglycemia to determine if additional intervention is needed. If BG remains <70 mg/dL,
repeat treatment and reassess in another 15 minutes.
Q4. Skyler Hansen's friends report he became confused and combative before losing
consciousness. The nurse recognizes these symptoms as:
A. Adrenergic manifestations of hypoglycemia
B. Neuroglycopenic manifestations of hypoglycemia [CORRECT]
C. Signs of hyperglycemic hyperosmolar state
D. Psychiatric emergency unrelated to diabetes
Correct Answer: B
Rationale: Confusion, combativeness, and altered mental status are neuroglycopenic
symptoms resulting from insufficient glucose supply to the brain. These symptoms often
precede loss of consciousness in severe hypoglycemia and require immediate glucose
replacement.
Q5. Which of the following are adrenergic symptoms of hypoglycemia? (Select all that apply)
A. Tremors [CORRECT]
B. Anxiety [CORRECT]
C. Diaphoresis [CORRECT]
D. Seizure activity
E. Hunger [CORRECT]
F. Visual disturbances
Correct Answers: A, B, C, E