NSG 3450 Exam 4 Questions with
ANSWERs and Rationales 2026
1. A 68-year-old male, Mr. Harrison, is sitting alone in a park. He is listening to loud, upbeat music
through headphones and appears to be rhythmically moving his hands. A passerby notices he seems
confused and calls for help. Upon assessment, he is diaphoretic and unable to state his name. What is
the nurse's priority action?
A. Remove the headphones to assess his orientation.
B. Check his blood glucose level.
C. Ask him if he is in pain.
D. Call for a psychiatric evaluation.
ANSWER: B. Check his blood glucose level.
Rationale:
Option A: While removing stimuli is helpful, the priority is to identify the physiological cause of his
confusion and diaphoresis.
Option B: The scenario presents signs of potential hypoglycemia (confusion, diaphoresis). Checking
blood glucose is a rapid, non-invasive, and critical first step to rule out this life-threatening metabolic
emergency.
Option C: Pain assessment is important but not the priority when the patient has an altered level of
consciousness and diaphoresis, which are classic signs of hypoglycemia or other acute metabolic issues.
Option D: A psychiatric evaluation is not the immediate priority. The patient's symptoms are more
consistent with a medical emergency that could lead to a psychiatric presentation, not a primary
psychiatric issue.
,2. Mr. Harrison's blood glucose is 45 mg/dL. He becomes increasingly agitated and tries to stand up.
Which of the following actions should the nurse take?
A. Administer 50% dextrose IV push as a rapid response.
B. Offer him a glass of orange juice.
C. Restrain him to prevent a fall.
D. Administer intramuscular glucagon.
ANSWER: A. Administer 50% dextrose IV push as a rapid response.
Rationale:
Option A: Mr. Harrison has severe hypoglycemia with an altered mental status and is becoming agitated.
An IV push of 50% dextrose is the fastest and most effective way to rapidly increase his blood glucose in
an emergency setting.
Option B: Oral glucose (orange juice) is unsafe in a patient who is confused and agitated due to the risk
of aspiration.
Option C: Restraints are a last resort and should not be the first action. De-escalation and treating the
underlying cause are the priorities. Restraints can increase agitation and risk of injury.
Option D: Glucagon is used when IV access is not available. Since the scenario implies the nurse is
assessing the patient, it is reasonable to assume IV access can be established, making IV dextrose the
preferred route.
3. After receiving 50% dextrose, Mr. Harrison's blood glucose normalizes to 110 mg/dL, but he remains
confused. He asks, "Where am I? Who are you?" Which of the following is the most appropriate next
step?
A. Reassure him and reorient him to place, time, and person.
B. Repeat the blood glucose check immediately.
C. Administer a dose of naloxone (Narcan).
D. Continue to monitor him until he is fully oriented.
,ANSWER: B. Repeat the blood glucose check immediately.
Rationale:
Option A: While reorientation is important, the persistence of confusion after treatment for
hypoglycemia is a red flag that warrants a re-evaluation of the blood glucose level. The initial treatment
may not have been sufficient, or he may have experienced a rebound hypoglycemic episode.
Option B: Rechecking the blood glucose is the most appropriate next step to ensure the treatment was
effective and to rule out a continued or recurring hypoglycemic event as the cause of his ongoing
confusion.
Option C: Naloxone is for opioid overdose, which is not suggested by the scenario. The patient's
symptoms were consistent with hypoglycemia, which has now been treated.
Option D: Continuing to monitor is appropriate but not the immediate next step. Reassessing the blood
glucose provides objective data to guide further care.
4. Upon further assessment, the nurse notes Mr. Harrison has a medical alert bracelet that states
"Diabetes Mellitus Type 1". He is also wearing a hospital ID band. What is the most significant
implication of this finding?
A. He should be treated for diabetic ketoacidosis (DKA).
B. He is at high risk for hypoglycemic unawareness.
C. He requires a strict carbohydrate-controlled diet.
D. He is likely experiencing a hyperglycemic crisis.
ANSWER: B. He is at high risk for hypoglycemic unawareness.
Rationale:
Option A: DKA is a complication of Type 1 diabetes, but his presentation (confusion, diaphoresis) is more
consistent with hypoglycemia. DKA typically presents with polyuria, polydipsia, and fruity breath.
, Option B: Patients with long-standing Type 1 diabetes are at high risk for hypoglycemic unawareness,
where the autonomic symptoms (sweating, palpitations) that typically warn of low blood sugar are
diminished or absent. This makes the confusion a more prominent and potentially dangerous sign.
Option C: While a controlled diet is part of diabetes management, it is not the most significant
implication of his alert bracelet in the context of his acute presentation.
Option D: Hyperglycemic crisis (DKA or HHS) usually presents with hyperglycemia, dehydration, and
altered mental status, but not necessarily the diaphoresis seen in hypoglycemia.
5. The nurse reviews Mr. Harrison's medication list. He takes Lispro insulin before meals. Based on his
presentation in the park, which of the following factors is MOST likely to have contributed to his
hypoglycemic episode?
A. He took his Lispro insulin but did not eat a meal.
B. He took his Lispro insulin after a large meal.
C. He took his long-acting insulin instead of his Lispro.
D. He increased his physical activity after eating.
ANSWER: A. He took his Lispro insulin but did not eat a meal.
Rationale:
Option A: Lispro is a rapid-acting insulin that peaks in about 1-2 hours. If administered without a
corresponding meal, it can cause a rapid and significant drop in blood glucose, leading to hypoglycemia.
Option B: Taking Lispro after a large meal would result in a delayed peak and could lead to postprandial
hyperglycemia, not hypoglycemia.
Option C: Taking a long-acting insulin instead of Lispro would cause a different pattern of hyperglycemia,
not the rapid drop seen with missed meals.
Option D: Increased physical activity after eating typically lowers glucose levels but is less likely to cause
a severe hypoglycemic episode than taking insulin without food.
ANSWERs and Rationales 2026
1. A 68-year-old male, Mr. Harrison, is sitting alone in a park. He is listening to loud, upbeat music
through headphones and appears to be rhythmically moving his hands. A passerby notices he seems
confused and calls for help. Upon assessment, he is diaphoretic and unable to state his name. What is
the nurse's priority action?
A. Remove the headphones to assess his orientation.
B. Check his blood glucose level.
C. Ask him if he is in pain.
D. Call for a psychiatric evaluation.
ANSWER: B. Check his blood glucose level.
Rationale:
Option A: While removing stimuli is helpful, the priority is to identify the physiological cause of his
confusion and diaphoresis.
Option B: The scenario presents signs of potential hypoglycemia (confusion, diaphoresis). Checking
blood glucose is a rapid, non-invasive, and critical first step to rule out this life-threatening metabolic
emergency.
Option C: Pain assessment is important but not the priority when the patient has an altered level of
consciousness and diaphoresis, which are classic signs of hypoglycemia or other acute metabolic issues.
Option D: A psychiatric evaluation is not the immediate priority. The patient's symptoms are more
consistent with a medical emergency that could lead to a psychiatric presentation, not a primary
psychiatric issue.
,2. Mr. Harrison's blood glucose is 45 mg/dL. He becomes increasingly agitated and tries to stand up.
Which of the following actions should the nurse take?
A. Administer 50% dextrose IV push as a rapid response.
B. Offer him a glass of orange juice.
C. Restrain him to prevent a fall.
D. Administer intramuscular glucagon.
ANSWER: A. Administer 50% dextrose IV push as a rapid response.
Rationale:
Option A: Mr. Harrison has severe hypoglycemia with an altered mental status and is becoming agitated.
An IV push of 50% dextrose is the fastest and most effective way to rapidly increase his blood glucose in
an emergency setting.
Option B: Oral glucose (orange juice) is unsafe in a patient who is confused and agitated due to the risk
of aspiration.
Option C: Restraints are a last resort and should not be the first action. De-escalation and treating the
underlying cause are the priorities. Restraints can increase agitation and risk of injury.
Option D: Glucagon is used when IV access is not available. Since the scenario implies the nurse is
assessing the patient, it is reasonable to assume IV access can be established, making IV dextrose the
preferred route.
3. After receiving 50% dextrose, Mr. Harrison's blood glucose normalizes to 110 mg/dL, but he remains
confused. He asks, "Where am I? Who are you?" Which of the following is the most appropriate next
step?
A. Reassure him and reorient him to place, time, and person.
B. Repeat the blood glucose check immediately.
C. Administer a dose of naloxone (Narcan).
D. Continue to monitor him until he is fully oriented.
,ANSWER: B. Repeat the blood glucose check immediately.
Rationale:
Option A: While reorientation is important, the persistence of confusion after treatment for
hypoglycemia is a red flag that warrants a re-evaluation of the blood glucose level. The initial treatment
may not have been sufficient, or he may have experienced a rebound hypoglycemic episode.
Option B: Rechecking the blood glucose is the most appropriate next step to ensure the treatment was
effective and to rule out a continued or recurring hypoglycemic event as the cause of his ongoing
confusion.
Option C: Naloxone is for opioid overdose, which is not suggested by the scenario. The patient's
symptoms were consistent with hypoglycemia, which has now been treated.
Option D: Continuing to monitor is appropriate but not the immediate next step. Reassessing the blood
glucose provides objective data to guide further care.
4. Upon further assessment, the nurse notes Mr. Harrison has a medical alert bracelet that states
"Diabetes Mellitus Type 1". He is also wearing a hospital ID band. What is the most significant
implication of this finding?
A. He should be treated for diabetic ketoacidosis (DKA).
B. He is at high risk for hypoglycemic unawareness.
C. He requires a strict carbohydrate-controlled diet.
D. He is likely experiencing a hyperglycemic crisis.
ANSWER: B. He is at high risk for hypoglycemic unawareness.
Rationale:
Option A: DKA is a complication of Type 1 diabetes, but his presentation (confusion, diaphoresis) is more
consistent with hypoglycemia. DKA typically presents with polyuria, polydipsia, and fruity breath.
, Option B: Patients with long-standing Type 1 diabetes are at high risk for hypoglycemic unawareness,
where the autonomic symptoms (sweating, palpitations) that typically warn of low blood sugar are
diminished or absent. This makes the confusion a more prominent and potentially dangerous sign.
Option C: While a controlled diet is part of diabetes management, it is not the most significant
implication of his alert bracelet in the context of his acute presentation.
Option D: Hyperglycemic crisis (DKA or HHS) usually presents with hyperglycemia, dehydration, and
altered mental status, but not necessarily the diaphoresis seen in hypoglycemia.
5. The nurse reviews Mr. Harrison's medication list. He takes Lispro insulin before meals. Based on his
presentation in the park, which of the following factors is MOST likely to have contributed to his
hypoglycemic episode?
A. He took his Lispro insulin but did not eat a meal.
B. He took his Lispro insulin after a large meal.
C. He took his long-acting insulin instead of his Lispro.
D. He increased his physical activity after eating.
ANSWER: A. He took his Lispro insulin but did not eat a meal.
Rationale:
Option A: Lispro is a rapid-acting insulin that peaks in about 1-2 hours. If administered without a
corresponding meal, it can cause a rapid and significant drop in blood glucose, leading to hypoglycemia.
Option B: Taking Lispro after a large meal would result in a delayed peak and could lead to postprandial
hyperglycemia, not hypoglycemia.
Option C: Taking a long-acting insulin instead of Lispro would cause a different pattern of hyperglycemia,
not the rapid drop seen with missed meals.
Option D: Increased physical activity after eating typically lowers glucose levels but is less likely to cause
a severe hypoglycemic episode than taking insulin without food.
