NUR104 | NUR104 Medsurg 2 Exam 2 Version 2 |
Questions with Correct Answers and Expert
Explanation for Each Question | Saint Paul’s School
of Nursing
1. A patient with Type 1 Diabetes is found unconscious and diaphoretic. After verifying
a blood glucose level of 42 mg/dL, which intervention is the priority for the nurse?
A. Administer 15 grams of oral glucose gel.
B. Wait 15 minutes and recheck the blood glucose.
C. Provide a snack of peanut butter and crackers.
D. Administer 1 mg of Glucagon intramuscularly.
Correct Answer: D
Expert Explanation: Glucagon is the treatment of choice for an unconscious patient
with severe hypoglycemia who does not have intravenous access. Oral glucose
cannot be given safely to an unconscious patient due to the high risk of aspiration.
Once the patient regains consciousness, a complex carbohydrate and protein snack
should follow to maintain levels. Monitoring the patient’s response and safety
during the recovery phase is essential for preventing rebound hypoglycemia.
Immediate intervention is required to prevent permanent neurological damage
from low glucose levels.
,2. A nurse is reviewing the lab results of a patient suspected of having Diabetic
Ketoacidosis (DKA). Which finding is most consistent with this diagnosis?
A. Serum bicarbonate of 24 mEq/L.
B. Arterial pH of 7.25.
C. Blood glucose of 140 mg/dL.
D. Negative ketones in the urine.
Correct Answer: B
Expert Explanation: An arterial pH of 7.25 indicates metabolic acidosis, which is a
hallmark sign of DKA. In this condition, the body burns fat for energy, leading to the
accumulation of acidic ketone bodies. Blood glucose levels in DKA are typically
significantly higher than 250 mg/dL rather than near normal. Positive ketones in
both the blood and urine would be expected findings for this acute complication.
Restoring fluid balance and administering insulin are the primary medical goals to
correct the underlying acidosis.
3. Which clinical manifestation should the nurse expect to find in a patient newly
diagnosed with Grave’s disease?
A. Bradycardia and weight gain.
B. Cold intolerance and lethargy.
C. Exophthalmos and tachycardia.
,D. Constipation and dry skin.
Correct Answer: C
Expert Explanation: Grave’s disease is an autoimmune form of hyperthyroidism
that results in an overactive metabolic state. Exophthalmos, or bulging of the eyes, is
a classic sign specific to this condition due to inflammation in the orbital tissues.
Tachycardia occurs because the excess thyroid hormone increases the heart rate
and overall cardiac output. Symptoms like bradycardia and weight gain are
associated with hypothyroidism, which is the opposite clinical state. The nurse
should prioritize monitoring cardiac rhythm and providing eye care to these
patients.
4. The nurse is providing education to a patient prescribed Levothyroxine for
hypothyroidism. Which instruction is most important?
A. Take the medication with a full meal at dinner.
B. Stop the medication if you feel your heart racing.
C. Only take the medication when symptoms of fatigue occur.
D. Take the medication on an empty stomach in the morning.
Correct Answer: D
Expert Explanation: Levothyroxine must be taken on an empty stomach to ensure
optimal absorption in the gastrointestinal tract. Patients are generally advised to
, take it 30 to 60 minutes before breakfast with a full glass of water. Taking it with
food or other medications can significantly decrease the bioavailability of the
hormone. This is a lifelong replacement therapy and should never be used on an ‘as-
needed’ basis. The nurse should also teach the patient to report signs of
hyperthyroidism, such as palpitations, to the provider.
5. A patient is scheduled for an IV contrast-enhanced CT scan. Which medication must
the nurse hold for 48 hours after the procedure?
A. Furosemide.
B. Lisinopril.
C. Metformin.
D. Atorvastatin.
Correct Answer: C
Expert Explanation: Metformin must be held before and for 48 hours after
procedures involving intravenous contrast dye. The combination of contrast dye
and metformin increases the risk of developing lactic acidosis if renal failure occurs.
Renal function, specifically creatinine levels, must be verified as normal before the
medication is resumed. Other medications like Lisinopril or Atorvastatin do not
carry this specific risk with contrast media. Nursing care involves ensuring the
patient stays well-hydrated to help flush the contrast through the kidneys.
Questions with Correct Answers and Expert
Explanation for Each Question | Saint Paul’s School
of Nursing
1. A patient with Type 1 Diabetes is found unconscious and diaphoretic. After verifying
a blood glucose level of 42 mg/dL, which intervention is the priority for the nurse?
A. Administer 15 grams of oral glucose gel.
B. Wait 15 minutes and recheck the blood glucose.
C. Provide a snack of peanut butter and crackers.
D. Administer 1 mg of Glucagon intramuscularly.
Correct Answer: D
Expert Explanation: Glucagon is the treatment of choice for an unconscious patient
with severe hypoglycemia who does not have intravenous access. Oral glucose
cannot be given safely to an unconscious patient due to the high risk of aspiration.
Once the patient regains consciousness, a complex carbohydrate and protein snack
should follow to maintain levels. Monitoring the patient’s response and safety
during the recovery phase is essential for preventing rebound hypoglycemia.
Immediate intervention is required to prevent permanent neurological damage
from low glucose levels.
,2. A nurse is reviewing the lab results of a patient suspected of having Diabetic
Ketoacidosis (DKA). Which finding is most consistent with this diagnosis?
A. Serum bicarbonate of 24 mEq/L.
B. Arterial pH of 7.25.
C. Blood glucose of 140 mg/dL.
D. Negative ketones in the urine.
Correct Answer: B
Expert Explanation: An arterial pH of 7.25 indicates metabolic acidosis, which is a
hallmark sign of DKA. In this condition, the body burns fat for energy, leading to the
accumulation of acidic ketone bodies. Blood glucose levels in DKA are typically
significantly higher than 250 mg/dL rather than near normal. Positive ketones in
both the blood and urine would be expected findings for this acute complication.
Restoring fluid balance and administering insulin are the primary medical goals to
correct the underlying acidosis.
3. Which clinical manifestation should the nurse expect to find in a patient newly
diagnosed with Grave’s disease?
A. Bradycardia and weight gain.
B. Cold intolerance and lethargy.
C. Exophthalmos and tachycardia.
,D. Constipation and dry skin.
Correct Answer: C
Expert Explanation: Grave’s disease is an autoimmune form of hyperthyroidism
that results in an overactive metabolic state. Exophthalmos, or bulging of the eyes, is
a classic sign specific to this condition due to inflammation in the orbital tissues.
Tachycardia occurs because the excess thyroid hormone increases the heart rate
and overall cardiac output. Symptoms like bradycardia and weight gain are
associated with hypothyroidism, which is the opposite clinical state. The nurse
should prioritize monitoring cardiac rhythm and providing eye care to these
patients.
4. The nurse is providing education to a patient prescribed Levothyroxine for
hypothyroidism. Which instruction is most important?
A. Take the medication with a full meal at dinner.
B. Stop the medication if you feel your heart racing.
C. Only take the medication when symptoms of fatigue occur.
D. Take the medication on an empty stomach in the morning.
Correct Answer: D
Expert Explanation: Levothyroxine must be taken on an empty stomach to ensure
optimal absorption in the gastrointestinal tract. Patients are generally advised to
, take it 30 to 60 minutes before breakfast with a full glass of water. Taking it with
food or other medications can significantly decrease the bioavailability of the
hormone. This is a lifelong replacement therapy and should never be used on an ‘as-
needed’ basis. The nurse should also teach the patient to report signs of
hyperthyroidism, such as palpitations, to the provider.
5. A patient is scheduled for an IV contrast-enhanced CT scan. Which medication must
the nurse hold for 48 hours after the procedure?
A. Furosemide.
B. Lisinopril.
C. Metformin.
D. Atorvastatin.
Correct Answer: C
Expert Explanation: Metformin must be held before and for 48 hours after
procedures involving intravenous contrast dye. The combination of contrast dye
and metformin increases the risk of developing lactic acidosis if renal failure occurs.
Renal function, specifically creatinine levels, must be verified as normal before the
medication is resumed. Other medications like Lisinopril or Atorvastatin do not
carry this specific risk with contrast media. Nursing care involves ensuring the
patient stays well-hydrated to help flush the contrast through the kidneys.
