Rasmussen College MDC 2 Exam 1 Study Guide
Medical-Surgical Nursing II (MDC 2)
Questions and Answers with Rationales
---
MDC 2 Exam 1: Endocrine, Gastrointestinal, and Renal/Urinary Systems**
1. A patient with Type 1 Diabetes Mellitus presents to the emergency department with
fruity breath, Kussmaul respirations, and abdominal pain. Which arterial blood gas
(ABG) result should the nurse expect?**
A. pH 7.35, PaCO2 45, HCO3 22
B. pH 7.50, PaCO2 30, HCO3 24
C. pH 7.25, PaCO2 30, HCO3 18
D. pH 7.30, PaCO2 50, HCO3 28
**Answer: C**
**Rationale:** The patient is exhibiting signs of Diabetic Ketoacidosis (DKA). In DKA, the
body produces ketones, which are metabolic acids, leading to metabolic acidosis.
Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate (HCO3).
Kussmaul respirations are the body's attempt to blow off CO2 to compensate (low
PaCO2).
**2. The nurse is teaching a patient about the Somogyi effect. Which statement by the
patient indicates understanding?**
A. "This happens when I take too much insulin at night."
,B. "This is when my blood sugar drops low at night, causing my body to release
hormones that raise my sugar by morning."
C. "This occurs because my body doesn't produce any insulin."
D. "This is caused by eating a snack right before bed."
**Answer: B**
**Rationale:** The Somogyi effect (rebound hyperglycemia) occurs when blood sugar
drops overnight (hypoglycemia). In response, the body releases counterregulatory
hormones (glucagon, epinephrine, cortisol), causing a rapid spike in blood sugar by
morning.
**3. A patient with hypothyroidism is prescribed levothyroxine (Synthroid). Which
instruction is most important for the nurse to include?**
A. "Take the medication with breakfast to avoid stomach upset."
B. "Take the medication at the same time every day, preferably in the morning on an
empty stomach."
C. "Expect to lose weight immediately after starting the medication."
D. "You may stop taking the medication once your symptoms improve."
**Answer: B**
**Rationale:** Levothyroxine should be taken on an empty stomach (usually 30-60
mins before breakfast) to enhance absorption. It should be taken at the same time
daily to maintain stable thyroid levels. It is a lifelong therapy.
**4. During a routine assessment, a nurse notes a patient has a protruding tongue,
coarse facial features, and dry skin. Which diagnostic test confirms the suspected
condition?**
A. Free T4 and TSH levels
B. Fasting blood glucose
C. Serum cortisol levels
D. Complete blood count (CBC)
, **Answer: A**
**Rationale:** These signs suggest myxedema (severe hypothyroidism). Diagnosis is
confirmed via thyroid function tests showing elevated TSH (due to negative feedback)
and low Free T4.
**5. A patient with Addison’s disease (adrenal insufficiency) is scheduled for surgery.
The nurse anticipates an order for which medication administration?**
A. Regular insulin
B. Stress dose corticosteroids (hydrocortisone)
C. Potassium-sparing diuretics
D. Levothyroxine
**Answer: B**
**Rationale:** Patients with Addison's disease cannot produce sufficient cortisol.
During stress (like surgery), the body requires extra cortisol to prevent Addisonian
crisis (acute adrenal insufficiency), which can be fatal.
**6. Which electrolyte imbalance is the priority concern for a patient diagnosed with
Cushing’s syndrome?**
A. Hypokalemia
B. Hypernatremia
C. Hyponatremia
D. Hypocalcemia
**Answer: A**
**Rationale:** Cushing's syndrome involves excessive cortisol. Cortisol has
mineralocorticoid effects that cause sodium retention (leading to water
retention/hypertension) and potassium excretion (hypokalemia). While hypernatremia
can occur, hypokalemia poses a higher risk for cardiac arrhythmias.
Medical-Surgical Nursing II (MDC 2)
Questions and Answers with Rationales
---
MDC 2 Exam 1: Endocrine, Gastrointestinal, and Renal/Urinary Systems**
1. A patient with Type 1 Diabetes Mellitus presents to the emergency department with
fruity breath, Kussmaul respirations, and abdominal pain. Which arterial blood gas
(ABG) result should the nurse expect?**
A. pH 7.35, PaCO2 45, HCO3 22
B. pH 7.50, PaCO2 30, HCO3 24
C. pH 7.25, PaCO2 30, HCO3 18
D. pH 7.30, PaCO2 50, HCO3 28
**Answer: C**
**Rationale:** The patient is exhibiting signs of Diabetic Ketoacidosis (DKA). In DKA, the
body produces ketones, which are metabolic acids, leading to metabolic acidosis.
Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate (HCO3).
Kussmaul respirations are the body's attempt to blow off CO2 to compensate (low
PaCO2).
**2. The nurse is teaching a patient about the Somogyi effect. Which statement by the
patient indicates understanding?**
A. "This happens when I take too much insulin at night."
,B. "This is when my blood sugar drops low at night, causing my body to release
hormones that raise my sugar by morning."
C. "This occurs because my body doesn't produce any insulin."
D. "This is caused by eating a snack right before bed."
**Answer: B**
**Rationale:** The Somogyi effect (rebound hyperglycemia) occurs when blood sugar
drops overnight (hypoglycemia). In response, the body releases counterregulatory
hormones (glucagon, epinephrine, cortisol), causing a rapid spike in blood sugar by
morning.
**3. A patient with hypothyroidism is prescribed levothyroxine (Synthroid). Which
instruction is most important for the nurse to include?**
A. "Take the medication with breakfast to avoid stomach upset."
B. "Take the medication at the same time every day, preferably in the morning on an
empty stomach."
C. "Expect to lose weight immediately after starting the medication."
D. "You may stop taking the medication once your symptoms improve."
**Answer: B**
**Rationale:** Levothyroxine should be taken on an empty stomach (usually 30-60
mins before breakfast) to enhance absorption. It should be taken at the same time
daily to maintain stable thyroid levels. It is a lifelong therapy.
**4. During a routine assessment, a nurse notes a patient has a protruding tongue,
coarse facial features, and dry skin. Which diagnostic test confirms the suspected
condition?**
A. Free T4 and TSH levels
B. Fasting blood glucose
C. Serum cortisol levels
D. Complete blood count (CBC)
, **Answer: A**
**Rationale:** These signs suggest myxedema (severe hypothyroidism). Diagnosis is
confirmed via thyroid function tests showing elevated TSH (due to negative feedback)
and low Free T4.
**5. A patient with Addison’s disease (adrenal insufficiency) is scheduled for surgery.
The nurse anticipates an order for which medication administration?**
A. Regular insulin
B. Stress dose corticosteroids (hydrocortisone)
C. Potassium-sparing diuretics
D. Levothyroxine
**Answer: B**
**Rationale:** Patients with Addison's disease cannot produce sufficient cortisol.
During stress (like surgery), the body requires extra cortisol to prevent Addisonian
crisis (acute adrenal insufficiency), which can be fatal.
**6. Which electrolyte imbalance is the priority concern for a patient diagnosed with
Cushing’s syndrome?**
A. Hypokalemia
B. Hypernatremia
C. Hyponatremia
D. Hypocalcemia
**Answer: A**
**Rationale:** Cushing's syndrome involves excessive cortisol. Cortisol has
mineralocorticoid effects that cause sodium retention (leading to water
retention/hypertension) and potassium excretion (hypokalemia). While hypernatremia
can occur, hypokalemia poses a higher risk for cardiac arrhythmias.
