NURS 201 Medical-Surgical Nursing - Week 12 Quiz 2026 |WCU
1. A patient with Diabetic Ketoacidosis (DKA) is being treated with an
intravenous insulin infusion. Which laboratory value requires the most
immediate intervention by the nurse?
A. Blood glucose level of 350 mg/dL
B. Blood pH of 7.25
C. Bicarbonate level of 15 mEq/L
D. Serum potassium level of 3.0 mEq/L
Answer: D
Rationale: Insulin shifts potassium into the cells, which can cause severe hypokalemia. A
potassium level of 3.0 mEq/L is critically low and must be addressed immediately to
prevent cardiac arrhythmias before continuing or starting insulin.
2. Which clinical manifestation is most characteristic of Hyperosmolar
Hyperglycemic State (HHS) compared to Diabetic Ketoacidosis (DKA)?
A. Kussmaul respirations
B. Fruity breath odor
C. Severe dehydration and high serum osmolality
D. Presence of significant ketonuria
Answer: C
Rationale: HHS is characterized by profound dehydration and extremely high glucose
levels causing high serum osmolality, usually without the significant ketosis or acidosis
seen in DKA.
,3. A nurse is teaching a patient with Type 2 Diabetes about Metformin. Which
statement should the nurse include regarding diagnostic tests?
A. Metformin must be held for 48 hours after receiving IV contrast media.
B. Metformin should be taken with a high-protein meal before the test.
C. There are no restrictions for Metformin regarding imaging tests.
D. The dose should be doubled on the day of a CT scan.
Answer: A
Rationale: Metformin can interact with iodinated contrast media and lead to acute renal
failure and lactic acidosis; it must be held 48 hours after the procedure.
4. At what time would the nurse expect NPH insulin, administered at 07:00, to
reach its peak action?
A. 08:00 to 09:00
B. 13:00 to 19:00
C. 10:00 to 11:00
D. 22:00 to 24:00
Answer: B
Rationale: NPH is an intermediate-acting insulin with a peak effect typically occurring 4 to
12 hours after administration.
5. A patient experiencing hypoglycemia is conscious but shaky and pale. What is
the nurse’s first action?
A. Administer 1 mg of Glucagon intramuscularly
B. Infuse 50 mL of 50% Dextrose IV push
C. Administer 15 grams of simple carbohydrates orally
D. Provide a complex carbohydrate like a sandwich
Answer: C
Rationale: The rule of 15 states that for a conscious patient, 15g of simple carbs should be
given first. Glucagon or D50W is reserved for unconscious or non-swallowing patients.
, 6. A patient’s blood glucose is high in the morning. To distinguish between the
Dawn Phenomenon and the Somogyi Effect, the nurse should:
A. Check the blood glucose at 03:00.
B. Increase the evening dose of NPH insulin.
C. Eliminate the bedtime snack.
D. Provide extra insulin before breakfast.
Answer: A
Rationale: The Somogyi effect involves hypoglycemia at 03:00 followed by rebound
hyperglycemia, whereas the Dawn Phenomenon shows normal or high glucose at 03:00.
7. Which instruction is essential for a nurse to include in diabetic foot care
education?
A. Soak feet daily in warm water to maintain hydration.
B. Apply lotion between the toes to prevent cracking.
C. Go barefoot at home to allow the skin to breathe.
D. Inspect the feet daily using a mirror if necessary.
Answer: D
Rationale: Daily inspection is critical for early detection of injuries. Soaking feet and
applying lotion between toes increases the risk of maceration and infection.
8. What is the primary significance of a Glycosylated Hemoglobin (A1C) level of
9%?
A. The patient is currently in a state of ketoacidosis.
B. The patient is experiencing acute hypoglycemia.
C. The patient has had poor glucose control over the last 3 months.
D. The patient’s kidney function is declining.
Answer: C
Rationale: The A1C test measures average blood glucose over the past 2-3 months. A level
of 9% indicates poor long-term glycemic control (target is usually <7%).
1. A patient with Diabetic Ketoacidosis (DKA) is being treated with an
intravenous insulin infusion. Which laboratory value requires the most
immediate intervention by the nurse?
A. Blood glucose level of 350 mg/dL
B. Blood pH of 7.25
C. Bicarbonate level of 15 mEq/L
D. Serum potassium level of 3.0 mEq/L
Answer: D
Rationale: Insulin shifts potassium into the cells, which can cause severe hypokalemia. A
potassium level of 3.0 mEq/L is critically low and must be addressed immediately to
prevent cardiac arrhythmias before continuing or starting insulin.
2. Which clinical manifestation is most characteristic of Hyperosmolar
Hyperglycemic State (HHS) compared to Diabetic Ketoacidosis (DKA)?
A. Kussmaul respirations
B. Fruity breath odor
C. Severe dehydration and high serum osmolality
D. Presence of significant ketonuria
Answer: C
Rationale: HHS is characterized by profound dehydration and extremely high glucose
levels causing high serum osmolality, usually without the significant ketosis or acidosis
seen in DKA.
,3. A nurse is teaching a patient with Type 2 Diabetes about Metformin. Which
statement should the nurse include regarding diagnostic tests?
A. Metformin must be held for 48 hours after receiving IV contrast media.
B. Metformin should be taken with a high-protein meal before the test.
C. There are no restrictions for Metformin regarding imaging tests.
D. The dose should be doubled on the day of a CT scan.
Answer: A
Rationale: Metformin can interact with iodinated contrast media and lead to acute renal
failure and lactic acidosis; it must be held 48 hours after the procedure.
4. At what time would the nurse expect NPH insulin, administered at 07:00, to
reach its peak action?
A. 08:00 to 09:00
B. 13:00 to 19:00
C. 10:00 to 11:00
D. 22:00 to 24:00
Answer: B
Rationale: NPH is an intermediate-acting insulin with a peak effect typically occurring 4 to
12 hours after administration.
5. A patient experiencing hypoglycemia is conscious but shaky and pale. What is
the nurse’s first action?
A. Administer 1 mg of Glucagon intramuscularly
B. Infuse 50 mL of 50% Dextrose IV push
C. Administer 15 grams of simple carbohydrates orally
D. Provide a complex carbohydrate like a sandwich
Answer: C
Rationale: The rule of 15 states that for a conscious patient, 15g of simple carbs should be
given first. Glucagon or D50W is reserved for unconscious or non-swallowing patients.
, 6. A patient’s blood glucose is high in the morning. To distinguish between the
Dawn Phenomenon and the Somogyi Effect, the nurse should:
A. Check the blood glucose at 03:00.
B. Increase the evening dose of NPH insulin.
C. Eliminate the bedtime snack.
D. Provide extra insulin before breakfast.
Answer: A
Rationale: The Somogyi effect involves hypoglycemia at 03:00 followed by rebound
hyperglycemia, whereas the Dawn Phenomenon shows normal or high glucose at 03:00.
7. Which instruction is essential for a nurse to include in diabetic foot care
education?
A. Soak feet daily in warm water to maintain hydration.
B. Apply lotion between the toes to prevent cracking.
C. Go barefoot at home to allow the skin to breathe.
D. Inspect the feet daily using a mirror if necessary.
Answer: D
Rationale: Daily inspection is critical for early detection of injuries. Soaking feet and
applying lotion between toes increases the risk of maceration and infection.
8. What is the primary significance of a Glycosylated Hemoglobin (A1C) level of
9%?
A. The patient is currently in a state of ketoacidosis.
B. The patient is experiencing acute hypoglycemia.
C. The patient has had poor glucose control over the last 3 months.
D. The patient’s kidney function is declining.
Answer: C
Rationale: The A1C test measures average blood glucose over the past 2-3 months. A level
of 9% indicates poor long-term glycemic control (target is usually <7%).
