U 189 / NU189 EXAM 2
N
2026-2027 | Medical-Surgical
Nursing II Guide | Galen College |
100% Verified Q&A | Grade A |
Pass Guaranteed
## PART A: MULTIPLE CHOICE (Q1–55)
* *Q1 (Endocrine – DKA):** A 22-year-old with type 1 diabetes presents with Kussmaul
respirations, fruity breath, and blood glucose of 520 mg/dL. Which IV fluid should the nurse
prepare to administer FIRST?
. 0.9% Normal Saline
A
B. D5W with ½ NS
C. Lactated Ringer's
D. D5W
* *[CORRECT]** A
*Rationale: 0.9% NS is the initial fluid of choice for DKA to restore intravascular volume and
correct dehydration; it does not contain glucose which would worsen hyperglycemia. D5W is
contraindicated initially as it contains dextrose. LR contains lactate which is converted to
glucose by the liver and is not first-line. Once glucose drops below 200 mg/dL,
dextrose-containing fluids are added to prevent hypoglycemia.*
---
* *Q2 (Endocrine – DKA):** Which arterial blood gas finding is MOST characteristic of diabetic
ketoacidosis?
. pH 7.48, PaCO₂ 32, HCO₃⁻ 24
A
B. pH 7.30, PaCO₂ 28, HCO₃⁻ 14
C. pH 7.35, PaCO₂ 40, HCO₃⁻ 22
D. pH 7.25, PaCO₂ 50, HCO₃⁻ 30
,* *[CORRECT]** B
*Rationale: DKA presents with metabolic acidosis (low pH <7.35, low HCO₃⁻ <18) with
compensatory respiratory alkalosis (low PaCO₂ via Kussmaul breathing). Option A shows
respiratory alkalosis without metabolic acidosis. Option C is normal. Option D shows respiratory
acidosis with metabolic alkalosis, which is the opposite pattern.*
---
* *Q3 (Endocrine – Insulin):** A patient with type 1 diabetes is prescribed insulin glargine
(Lantus) 20 units at bedtime and insulin lispro (Humalog) with meals. The patient asks why two
insulins are needed. What is the nurse's BEST response?
. "The glargine covers your meals and the lispro covers your baseline needs."
A
B. "The glargine provides basal coverage and the lispro covers mealtime glucose spikes."
C. "You only need the glargine; the lispro is optional for convenience."
D. "The lispro is for emergencies only when your glucose is very high."
* *[CORRECT]** B
*Rationale: Basal-bolus insulin therapy mimics physiologic insulin secretion—glargine
(long-acting) provides continuous basal coverage, while lispro (rapid-acting) covers prandial
glucose excursions. Option A reverses their roles. Option C is incorrect as both are essential.
Option D is wrong because rapid-acting insulin is scheduled, not PRN.*
---
* *Q4 (Endocrine – Hypoglycemia):** A patient with type 1 diabetes becomes diaphoretic,
tremulous, and confused with a blood glucose of 48 mg/dL. The patient is alert and able to
swallow. What is the FIRST action?
. Administer 1 mg glucagon IM
A
B. Give 15 grams of fast-acting carbohydrate
C. Start D50 IV push
D. Recheck glucose in 15 minutes
* *[CORRECT]** B
*Rationale: The "Rule of 15" for conscious hypoglycemic patients: give 15g fast-acting carbs
(glucose tablets, juice), recheck in 15 minutes, repeat if still <70 mg/dL. Glucagon IM (Option A)
and D50 IV (Option C) are for unconscious or NPO patients. Rechecking first (Option D) delays
treatment.*
---
,* *Q5 (Endocrine – Oral Agents):** Which oral antidiabetic agent works by inhibiting SGLT2 in
the kidneys, promoting glucosuria and offering cardiovascular protection?
. Metformin
A
B. Glipizide
C. Empagliflozin
D. Pioglitazone
* *[CORRECT]** C
*Rationale: Empagliflozin is an SGLT2 inhibitor that blocks glucose reabsorption in proximal
tubules, lowering blood glucose and reducing CV mortality (EMPA-REG OUTCOME trial).
Metformin (Option A) decreases hepatic glucose production. Glipizide (Option B) is a
sulfonylurea stimulating insulin secretion. Pioglitazone (Option D) is a TZD improving insulin
sensitivity.*
---
* *Q6 (Endocrine – Thyroid):** A patient with Graves' disease develops a fever of 103.2°F,
tachycardia (HR 160), agitation, and vomiting. Which medication should the nurse prepare to
administer FIRST?
. Propylthiouracil (PTU)
A
B. Propranolol
C. Iodine (Lugol's solution)
D. Hydrocortisone
* *[CORRECT]** A
*Rationale: Thyroid storm requires immediate thionamide therapy (PTU or methimazole) to
block new hormone synthesis—PTU also blocks peripheral T4→T3 conversion. Propranolol
(Option B) controls adrenergic symptoms but does not address hormone overproduction. Iodine
(Option C) is given 1 hour AFTER thionamides to prevent iodine utilization for new hormone
synthesis. Hydrocortisone (Option D) supports adrenal function but is not first-line.*
---
* *Q7 (Endocrine – Thyroid):** A patient with hypothyroidism is started on levothyroxine. Which
instruction is MOST important for the nurse to provide?
. "Take the medication at bedtime with a snack."
A
B. "Take the medication on an empty stomach 30-60 minutes before breakfast."
C. "Take the medication with your morning coffee for better absorption."
D. "You can take this medication at any time of day as long as you are consistent."
**[CORRECT]** B
, * Rationale: Levothyroxine absorption is optimized when taken on an empty stomach 30-60
minutes before breakfast; food, coffee, calcium, and iron significantly reduce absorption.
Bedtime administration (Option A) is less optimal due to circadian rhythm effects. Coffee (Option
C) decreases absorption by 55%. While consistency matters (Option D), timing relative to food
is critical.*
---
* *Q8 (Endocrine – Adrenal):** A patient with Addison's disease is admitted with vomiting and
hypotension. Laboratory studies show hyperkalemia and hyponatremia. The nurse should
anticipate which immediate intervention?
. Administer IV potassium chloride
A
B. Administer IV hydrocortisone and IV fluids with dextrose
C. Start an insulin drip to shift potassium intracellularly
D. Administer IV furosemide to promote potassium excretion
* *[CORRECT]** B
*Rationale: Addisonian crisis is an adrenal emergency treated with immediate IV hydrocortisone
(glucocorticoid replacement) and IV fluids (usually D5NS) to correct hypovolemia and
hyponatremia. Giving potassium (Option A) would worsen hyperkalemia. Insulin drip (Option C)
and furosemide (Option D) are not appropriate as the primary treatment; corticosteroid
replacement is life-saving.*
---
* *Q9 (Endocrine – Cushing's):** A patient with Cushing's syndrome is at highest risk for which
complication?
. Hypotension and bradycardia
A
B. Hyperglycemia and osteoporosis
C. Hypokalemia and weight loss
D. Hyponatremia and hypothermia
* *[CORRECT]** B
*Rationale: Cushing's syndrome causes cortisol excess leading to hyperglycemia
(gluconeogenesis), protein catabolism (muscle wasting, osteoporosis), and central obesity.
Hypertension (not hypotension) and tachycardia occur due to mineralocorticoid effects.
Hypokalemia may occur but weight GAIN (not loss) is characteristic. Hyponatremia and
hypothermia are seen in Addison's disease, not Cushing's.*
---
N
2026-2027 | Medical-Surgical
Nursing II Guide | Galen College |
100% Verified Q&A | Grade A |
Pass Guaranteed
## PART A: MULTIPLE CHOICE (Q1–55)
* *Q1 (Endocrine – DKA):** A 22-year-old with type 1 diabetes presents with Kussmaul
respirations, fruity breath, and blood glucose of 520 mg/dL. Which IV fluid should the nurse
prepare to administer FIRST?
. 0.9% Normal Saline
A
B. D5W with ½ NS
C. Lactated Ringer's
D. D5W
* *[CORRECT]** A
*Rationale: 0.9% NS is the initial fluid of choice for DKA to restore intravascular volume and
correct dehydration; it does not contain glucose which would worsen hyperglycemia. D5W is
contraindicated initially as it contains dextrose. LR contains lactate which is converted to
glucose by the liver and is not first-line. Once glucose drops below 200 mg/dL,
dextrose-containing fluids are added to prevent hypoglycemia.*
---
* *Q2 (Endocrine – DKA):** Which arterial blood gas finding is MOST characteristic of diabetic
ketoacidosis?
. pH 7.48, PaCO₂ 32, HCO₃⁻ 24
A
B. pH 7.30, PaCO₂ 28, HCO₃⁻ 14
C. pH 7.35, PaCO₂ 40, HCO₃⁻ 22
D. pH 7.25, PaCO₂ 50, HCO₃⁻ 30
,* *[CORRECT]** B
*Rationale: DKA presents with metabolic acidosis (low pH <7.35, low HCO₃⁻ <18) with
compensatory respiratory alkalosis (low PaCO₂ via Kussmaul breathing). Option A shows
respiratory alkalosis without metabolic acidosis. Option C is normal. Option D shows respiratory
acidosis with metabolic alkalosis, which is the opposite pattern.*
---
* *Q3 (Endocrine – Insulin):** A patient with type 1 diabetes is prescribed insulin glargine
(Lantus) 20 units at bedtime and insulin lispro (Humalog) with meals. The patient asks why two
insulins are needed. What is the nurse's BEST response?
. "The glargine covers your meals and the lispro covers your baseline needs."
A
B. "The glargine provides basal coverage and the lispro covers mealtime glucose spikes."
C. "You only need the glargine; the lispro is optional for convenience."
D. "The lispro is for emergencies only when your glucose is very high."
* *[CORRECT]** B
*Rationale: Basal-bolus insulin therapy mimics physiologic insulin secretion—glargine
(long-acting) provides continuous basal coverage, while lispro (rapid-acting) covers prandial
glucose excursions. Option A reverses their roles. Option C is incorrect as both are essential.
Option D is wrong because rapid-acting insulin is scheduled, not PRN.*
---
* *Q4 (Endocrine – Hypoglycemia):** A patient with type 1 diabetes becomes diaphoretic,
tremulous, and confused with a blood glucose of 48 mg/dL. The patient is alert and able to
swallow. What is the FIRST action?
. Administer 1 mg glucagon IM
A
B. Give 15 grams of fast-acting carbohydrate
C. Start D50 IV push
D. Recheck glucose in 15 minutes
* *[CORRECT]** B
*Rationale: The "Rule of 15" for conscious hypoglycemic patients: give 15g fast-acting carbs
(glucose tablets, juice), recheck in 15 minutes, repeat if still <70 mg/dL. Glucagon IM (Option A)
and D50 IV (Option C) are for unconscious or NPO patients. Rechecking first (Option D) delays
treatment.*
---
,* *Q5 (Endocrine – Oral Agents):** Which oral antidiabetic agent works by inhibiting SGLT2 in
the kidneys, promoting glucosuria and offering cardiovascular protection?
. Metformin
A
B. Glipizide
C. Empagliflozin
D. Pioglitazone
* *[CORRECT]** C
*Rationale: Empagliflozin is an SGLT2 inhibitor that blocks glucose reabsorption in proximal
tubules, lowering blood glucose and reducing CV mortality (EMPA-REG OUTCOME trial).
Metformin (Option A) decreases hepatic glucose production. Glipizide (Option B) is a
sulfonylurea stimulating insulin secretion. Pioglitazone (Option D) is a TZD improving insulin
sensitivity.*
---
* *Q6 (Endocrine – Thyroid):** A patient with Graves' disease develops a fever of 103.2°F,
tachycardia (HR 160), agitation, and vomiting. Which medication should the nurse prepare to
administer FIRST?
. Propylthiouracil (PTU)
A
B. Propranolol
C. Iodine (Lugol's solution)
D. Hydrocortisone
* *[CORRECT]** A
*Rationale: Thyroid storm requires immediate thionamide therapy (PTU or methimazole) to
block new hormone synthesis—PTU also blocks peripheral T4→T3 conversion. Propranolol
(Option B) controls adrenergic symptoms but does not address hormone overproduction. Iodine
(Option C) is given 1 hour AFTER thionamides to prevent iodine utilization for new hormone
synthesis. Hydrocortisone (Option D) supports adrenal function but is not first-line.*
---
* *Q7 (Endocrine – Thyroid):** A patient with hypothyroidism is started on levothyroxine. Which
instruction is MOST important for the nurse to provide?
. "Take the medication at bedtime with a snack."
A
B. "Take the medication on an empty stomach 30-60 minutes before breakfast."
C. "Take the medication with your morning coffee for better absorption."
D. "You can take this medication at any time of day as long as you are consistent."
**[CORRECT]** B
, * Rationale: Levothyroxine absorption is optimized when taken on an empty stomach 30-60
minutes before breakfast; food, coffee, calcium, and iron significantly reduce absorption.
Bedtime administration (Option A) is less optimal due to circadian rhythm effects. Coffee (Option
C) decreases absorption by 55%. While consistency matters (Option D), timing relative to food
is critical.*
---
* *Q8 (Endocrine – Adrenal):** A patient with Addison's disease is admitted with vomiting and
hypotension. Laboratory studies show hyperkalemia and hyponatremia. The nurse should
anticipate which immediate intervention?
. Administer IV potassium chloride
A
B. Administer IV hydrocortisone and IV fluids with dextrose
C. Start an insulin drip to shift potassium intracellularly
D. Administer IV furosemide to promote potassium excretion
* *[CORRECT]** B
*Rationale: Addisonian crisis is an adrenal emergency treated with immediate IV hydrocortisone
(glucocorticoid replacement) and IV fluids (usually D5NS) to correct hypovolemia and
hyponatremia. Giving potassium (Option A) would worsen hyperkalemia. Insulin drip (Option C)
and furosemide (Option D) are not appropriate as the primary treatment; corticosteroid
replacement is life-saving.*
---
* *Q9 (Endocrine – Cushing's):** A patient with Cushing's syndrome is at highest risk for which
complication?
. Hypotension and bradycardia
A
B. Hyperglycemia and osteoporosis
C. Hypokalemia and weight loss
D. Hyponatremia and hypothermia
* *[CORRECT]** B
*Rationale: Cushing's syndrome causes cortisol excess leading to hyperglycemia
(gluconeogenesis), protein catabolism (muscle wasting, osteoporosis), and central obesity.
Hypertension (not hypotension) and tachycardia occur due to mineralocorticoid effects.
Hypokalemia may occur but weight GAIN (not loss) is characteristic. Hyponatremia and
hypothermia are seen in Addison's disease, not Cushing's.*
---
