NUR 206 Exam 3 Review: Diabetes, GI Disorders, Respiratory, GU, Pain Management Latest 2026/2027 Update | Complete Q&A with Verified Answers and Detailed Rationales | Medical-Surgical Nursing | Diabetes Mellitus Types 1 & 2, DKA, HHNS, Insulin Therapy, Pe

INSTANT PDF DOWNLOAD — This comprehensive EXAM review resource for NUR 206 Exam 3 (Medical-Surgical Nursing) at Fortis College covers all essential topics for the 2026/2027 academic year. It features exam-style questions with verified answers and detailed rationales covering diabetes mellitus (Type 1 and Type 2), DKA and HHNS, insulin therapy and oral antidiabetic agents, gastrointestinal disorders including peptic ulcer disease, GERD, appendicitis, hepatitis, cirrhosis, and pancreatitis, respiratory disorders including COPD, pneumonia, asthma, and tuberculosis, genitourinary disorders including UTIs, pyelonephritis, kidney stones, and BPH, and pain management including opioid and non-opioid analgesics, PCA pumps, epidural analgesia, and non-pharmacologic interventions . NUR 206 EXAM 3 – COMPLETE Q&A REVIEW DIABETES MELLITUS Question 1: A nurse is teaching a client with Type 1 diabetes about the signs and symptoms of diabetic ketoacidosis (DKA). Which of the following should the nurse include in the teaching? (Select all that apply) A) Fruity breath odor B) Deep, rapid respirations (Kussmaul breathing) C) Bradycardia D) Warm, dry skin E) Nausea and vomiting Correct Answers: A, B, E Rationale: DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis. Clinical manifestations include polyuria, polydipsia, weakness, nausea and vomiting, abdominal pain, Kussmaul respirations (deep, rapid breathing), fruity breath odor (from acetone), dehydration, tachycardia (not bradycardia), and altered mental status. Warm, dry skin is characteristic of HHNS, not DKA. Early recognition and treatment are essential to prevent severe metabolic decompensation and cerebral edema, particularly in children. Question 2: A client with Type 2 diabetes is prescribed metformin. Which statement by the client indicates a need for further teaching? A) "I will take this medication with food to prevent stomach upset." B) "I should report any unusual muscle pain or weakness to my provider." C) "I will stop taking my metformin for 48 hours before my CT scan with contrast dye." D) "This medication increases insulin production in my pancreas." Correct Answer: D) "This medication increases insulin production in my pancreas." Rationale: Metformin is a biguanide that works primarily by decreasing hepatic glucose production (gluconeogenesis) and increasing peripheral glucose uptake in muscle and fat . It does NOT increase insulin secretion from the pancreas. Metformin is considered first-line therapy for Type 2 diabetes because it is effective, does not cause weight gain, and has a low risk of hypoglycemia when used as monotherapy. Common side effects include gastrointestinal distress (nausea, diarrhea), which can be minimized by taking with food and gradual dose titration. Metformin should be held before procedures involving iodinated contrast dye (48 hours before and after) to prevent lactic acidosis, which is a rare but serious complication. Clients should be educated to report signs of lactic acidosis (unexplained hyperventilation, myalgia, malaise, unusual somnolence) . Question 3: A client with Type 1 diabetes is experiencing hypoglycemia with a blood glucose level of 45 mg/dL. The client is conscious and able to swallow. Which intervention should the nurse implement first? A) Administer glucagon 1 mg IM B) Give 15 grams of a fast-acting carbohydrate C) Start an IV and administer 50% dextrose D) Recheck blood glucose in 15 minutes Correct Answer: B) Give 15 grams of a fast-acting carbohydrate Rationale: For a conscious client with hypoglycemia who can swallow safely, the first intervention is the "Rule of 15": administer 15 grams of fast-acting carbohydrate (e.g., 4 oz of fruit juice or regular soda, 3-4 glucose tablets, 1 tablespoon of honey or sugar, or 5-6 hard candies). Recheck blood glucose in 15 minutes. If still below 70 mg/dL, repeat the 15g carbohydrate. Once blood glucose returns to normal, a snack containing complex carbohydrate and protein should be given if the next meal is more than 1 hour away. IV dextrose (50 mL of D50W) is used for unconscious patients or those unable to swallow safely. Glucagon is used for severe hypoglycemia when IV access is not available, but it is not first-line for a conscious patient . Question 4: The nurse is caring for a client newly diagnosed with Type 2 diabetes. The client's hemoglobin A1c is 9.5%. Which medication would the nurse expect to be prescribed as first-line therapy? A) Glipizide (Glucotrol) B) Metformin (Glucophage) C) Insulin glargine (Lantus) D) Pioglitazone (Actos) Correct Answer: B) Metformin (Glucophage) Rationale: Metformin is the recommended first-line pharmacologic treatment for Type 2 diabetes according to the American Diabetes Association (ADA) Standards of Care. It is effective at lowering A1c (by approximately 1.5%), does not cause weight gain, and has a low risk of hypoglycemia. Metformin also has cardiovascular benefits. The ADA recommends metformin be started at the time of diagnosis along with lifestyle modifications. Other medications (sulfonylureas, thiazolidinediones, GLP-1 agonists, SGLT2 inhibitors, or insulin) may be added if A1c remains above goal despite metformin and lifestyle changes. Question 5: A nurse is reviewing the laboratory results for a client with suspected hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which finding is consistent with HHNS rather than DKA? A) Serum glucose 450 mg/dL B) pH 7.32 C) Positive serum ketones D) Serum osmolality of 350 mOsm/kg Correct Answer: D) Serum osmolality of 350 mOsm/kg Rationale: HHNS is characterized by severe hyperglycemia (often 600 mg/dL, sometimes exceeding 1,000 mg/dL), profound dehydration, and hyperosmolality (serum osmolality typically 320 mOsm/kg) . Unlike DKA, HHNS presents with only minimal or no ketosis and no significant acidosis (pH 7.30). Both conditions can present with altered mental status, but HHNS is more likely to cause neurological symptoms such as lethargy, confusion, and even coma due to the extreme hyperosmolality. The mortality rate for HHNS is higher than for DKA, often due to underlying precipitating causes (e.g., sepsis, MI, stroke). Question 6: Which statement by a client with Type 2 diabetes indicates understanding of proper foot care? (Select all that apply) A) "I will soak my feet in hot water every day to soften calluses." B) "I will inspect my feet daily for blisters or redness." C) "I will wear cotton socks and change them daily." D) "I will cut my own toenails in a rounded shape." E) "I will apply lotion between my toes to prevent cracking." Correct Answers: B, C