NUR 220 | NUR 220 Medical Surgical Nursing Exam
3 Version 1 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. Which of the following is considered a classic symptom of hyperglycemia?
A. Profuse sweating
B. Tremors and shakiness
C. Cold and clammy skin
D. Extreme thirst (polydipsia)
Correct Answer: D
Expert Explanation: Hyperglycemia typically manifests as the three Ps: polyuria,
polydipsia, and polyphagia. Polydipsia refers to excessive thirst caused by high
glucose levels in the blood. This occurs because the body attempts to dilute the
sugar and excrete it through urine. In contrast, tremors and diaphoresis are
common signs of hypoglycemia rather than hyperglycemia. Monitoring blood
glucose levels is essential for accurate clinical assessment and intervention.
2. A patient with cirrhosis has an elevated ammonia level. Which medication should
the nurse expect to administer?
A. Lactulose
,B. Furosemide
C. Pantoprazole
D. Spironolactone
Correct Answer: A
Expert Explanation: Lactulose is the primary medication used to treat high
ammonia levels in patients with liver failure. It works by drawing ammonia from the
blood into the colon to be excreted. The medication also acts as an osmotic laxative,
resulting in multiple soft stools. Reducing ammonia is critical to preventing hepatic
encephalopathy and neurological decline. The effectiveness of the drug is measured
by a decrease in the patient’s confusion.
3. When should the nurse plan to administer a rapid-acting insulin like Lispro
(Humalog)?
A. 30 to 60 minutes before a meal
B. Only at bedtime
C. Two hours after a meal
D. 15 minutes before or immediately after a meal
Correct Answer: D
,Expert Explanation: Rapid-acting insulin has a very quick onset of action, usually
within 15 minutes. It is specifically designed to manage postprandial glucose spikes
when the patient eats. If the meal is delayed after administration, the patient is at
high risk for hypoglycemia. Nurses must ensure the food tray is available before
giving the injection. Proper timing is vital for maintaining stable blood sugar levels
throughout the day.
4. Which laboratory value is the best indicator of a diabetic patient’s glucose control
over the last three months?
A. Hemoglobin A1c
B. Post-prandial glucose
C. Fasting blood glucose
D. Serum ketones
Correct Answer: A
Expert Explanation: The Hemoglobin A1c test measures the average blood sugar
levels over approximately 90 days. It reflects how much glucose has permanently
attached to the red blood cells. Unlike a fingerstick, it is not affected by recent meals
or short-term exercise. This test is the gold standard for monitoring the
effectiveness of a diabetes management plan. A target level for most diabetic adults
is usually below seven percent.
, 5. A patient is admitted with suspected acute pancreatitis. Which lab result would
most strongly support this diagnosis?
A. Decreased white blood cell count
B. Elevated serum lipase
C. Decreased serum glucose
D. Elevated serum calcium
Correct Answer: B
Expert Explanation: Serum lipase is a highly specific enzyme used to diagnose
inflammation of the pancreas. In acute pancreatitis, lipase levels rise significantly
and remain elevated longer than amylase. These enzymes leak into the bloodstream
when pancreatic cells are damaged or inflamed. High levels often correlate with
clinical symptoms like severe epigastric pain. Managing this condition usually
involves keeping the patient NPO to rest the organ.
6. Which dietary instruction is most appropriate for a patient with liver cirrhosis and
significant ascites?
A. Increase sodium intake to 4 grams daily
B. Restrict dietary protein to zero
C. Follow a low-sodium diet
3 Version 1 | Questions with Correct Answers and
Expert Explanation for Each Question | Baltimore
City Community College
1. Which of the following is considered a classic symptom of hyperglycemia?
A. Profuse sweating
B. Tremors and shakiness
C. Cold and clammy skin
D. Extreme thirst (polydipsia)
Correct Answer: D
Expert Explanation: Hyperglycemia typically manifests as the three Ps: polyuria,
polydipsia, and polyphagia. Polydipsia refers to excessive thirst caused by high
glucose levels in the blood. This occurs because the body attempts to dilute the
sugar and excrete it through urine. In contrast, tremors and diaphoresis are
common signs of hypoglycemia rather than hyperglycemia. Monitoring blood
glucose levels is essential for accurate clinical assessment and intervention.
2. A patient with cirrhosis has an elevated ammonia level. Which medication should
the nurse expect to administer?
A. Lactulose
,B. Furosemide
C. Pantoprazole
D. Spironolactone
Correct Answer: A
Expert Explanation: Lactulose is the primary medication used to treat high
ammonia levels in patients with liver failure. It works by drawing ammonia from the
blood into the colon to be excreted. The medication also acts as an osmotic laxative,
resulting in multiple soft stools. Reducing ammonia is critical to preventing hepatic
encephalopathy and neurological decline. The effectiveness of the drug is measured
by a decrease in the patient’s confusion.
3. When should the nurse plan to administer a rapid-acting insulin like Lispro
(Humalog)?
A. 30 to 60 minutes before a meal
B. Only at bedtime
C. Two hours after a meal
D. 15 minutes before or immediately after a meal
Correct Answer: D
,Expert Explanation: Rapid-acting insulin has a very quick onset of action, usually
within 15 minutes. It is specifically designed to manage postprandial glucose spikes
when the patient eats. If the meal is delayed after administration, the patient is at
high risk for hypoglycemia. Nurses must ensure the food tray is available before
giving the injection. Proper timing is vital for maintaining stable blood sugar levels
throughout the day.
4. Which laboratory value is the best indicator of a diabetic patient’s glucose control
over the last three months?
A. Hemoglobin A1c
B. Post-prandial glucose
C. Fasting blood glucose
D. Serum ketones
Correct Answer: A
Expert Explanation: The Hemoglobin A1c test measures the average blood sugar
levels over approximately 90 days. It reflects how much glucose has permanently
attached to the red blood cells. Unlike a fingerstick, it is not affected by recent meals
or short-term exercise. This test is the gold standard for monitoring the
effectiveness of a diabetes management plan. A target level for most diabetic adults
is usually below seven percent.
, 5. A patient is admitted with suspected acute pancreatitis. Which lab result would
most strongly support this diagnosis?
A. Decreased white blood cell count
B. Elevated serum lipase
C. Decreased serum glucose
D. Elevated serum calcium
Correct Answer: B
Expert Explanation: Serum lipase is a highly specific enzyme used to diagnose
inflammation of the pancreas. In acute pancreatitis, lipase levels rise significantly
and remain elevated longer than amylase. These enzymes leak into the bloodstream
when pancreatic cells are damaged or inflamed. High levels often correlate with
clinical symptoms like severe epigastric pain. Managing this condition usually
involves keeping the patient NPO to rest the organ.
6. Which dietary instruction is most appropriate for a patient with liver cirrhosis and
significant ascites?
A. Increase sodium intake to 4 grams daily
B. Restrict dietary protein to zero
C. Follow a low-sodium diet
