University of South Alabama NU 327: All Cases Exam | Questions and Answer Key with Rationales| 100% Updated Summer 2025/26.

University of South Alabama NU 327: All Cases Exam | Questions and Answer Key with Rationales| 100% Updated Summer 2025/26. Case 1: Type 1 Diabetes Onset A 14-year-old patient presents to the emergency department with nausea, fatigue, fruity- smelling breath, and deep rapid respirations. Lab results show blood glucose of 430 mg/dL, ketonuria, and a pH of 7.1. Q1. What pathophysiological process is most likely occurring? A. Glycogenesis B. Glycogenolysis C. Hyperinsulinemia D. Gluconeogenesis Q2. What clinical signs are most consistent with Diabetic Ketoacidosis (DKA)? (Select all that apply) A. Fruity-smelling breath B. Bradycardia C. Kussmaul respirations D. Metabolic alkalosis E. Polyuria Q3. True or False: DKA results in hyperkalemia due to dehydration and acidosis. Case 2: Type 2 Diabetes and Insulin Resistance A 58-year-old obese male presents for routine screening. He has central obesity and reports fatigue and increased thirst. Lab results show FPG of 142 mg/dL and HbA1c of 8.2%. Q4. Which of the following best describes the pathophysiology of Type 2 Diabetes? A. Absolute deficiency of insulin due to beta-cell destruction B. Immune-mediated hypersensitivity of insulin receptors C. Resistance to insulin with relative insulin deficiency D. Overproduction of insulin by the liver Q5. Which of the following are modifiable risk factors for developing Type 2 Diabetes? (Select all that apply) A. Age over 65 B. Sedentary lifestyle C. Obesity D. Genetic mutations E. Abdominal adiposity Q6. True or False: Polyuria and polydipsia are exclusive to Type 1 Diabetes. Case 3: Exercise and Blood Glucose A patient with Type 1 Diabetes begins an aerobic exercise program. Q7. What hormonal changes occur during exercise in this patient? (Select all that apply) A. Insulin levels rise B. Glucagon levels rise C. Lipolysis is suppressed D. Glycogenolysis is stimulated E. Muscle cells increase insulin sensitivity Q8. What is the primary concern for a Type 1 Diabetic during prolonged exercise? A. Respiratory alkalosis B. Hyperkalemia C. Hypoglycemia D. DKA Case 4: Gestational Diabetes A pregnant woman is diagnosed with gestational diabetes. Q9. Which of the following fetal complications is most associated with untreated gestational diabetes? A. Microcephaly B. Macrosomia C. Low birth weight D. Bradycardia Q10. True or False: Gestational diabetes has no long-term health implications for the mother. Case 5: Complications of Diabetes A 72-year-old woman with poorly managed Type 2 Diabetes reports decreased sensation in her feet. She also has a non-healing wound on her heel. Q11. Which of the following complications are likely present? (Select all that apply) A. Neuropathy B. Retinopathy C. Nephropathy D. Hyperosmolar coma E. Peripheral vascular disease Q12. What pathophysiologic mechanism leads to neuropathy in diabetes? A. Hypokalemia B. Osmotic fluid loss C. Basement membrane thickening in capillaries D. Immune cell infiltration in nerves Q13. True or False: Microvascular complications of diabetes include nephropathy and retinopathy. Case 6: Hypoglycemia A patient with diabetes reports dizziness, confusion, and sweating after skipping a meal but taking insulin. Q14. Which symptoms are associated with hypoglycemia? (Select all that apply) A. Sweating B. Mental confusion C. Kussmaul respirations D. Cold, clammy skin E. Fruity breath Q15. What is the initial nursing priority? A. Call the provider B. Administer glucagon or carbohydrate C. Administer insulin D. Insert IV access Case 7: Diagnostic Criteria A 47-year-old patient with no prior diagnosis has the following labs: FPG = 128 mg/dL, OGTT (2hr) = 212 mg/dL, Random glucose = 201 mg/dL, HbA1c = 7.5%. Q16. Based on the diagnostic criteria, this patient: A. Has normal glucose tolerance B. Has pre-diabetes C. Meets the criteria for Diabetes Mellitus D. Is experiencing transient hyperglycemia Q17. True or False: A diagnosis of Diabetes Mellitus requires two abnormal tests from the same blood draw. Case 8: Metabolic Syndrome A 50-year-old male is noted to have central obesity, elevated lipids, hypertension, and elevated insulin levels. Q18. What condition is he most likely experiencing? A. Type 1 Diabetes B. Metabolic Syndrome C. Cushing’s Syndrome D. Graves’ Disease Q19. Which of the following are features of metabolic syndrome? (Select all that apply) A. Elevated circulating insulin B. Low HDL cholesterol C. Abdominal obesity D. Decreased circulating lipids E. Hypertension Q20. True or False: Children cannot develop metabolic syndrome. Case 1: Fracture and Complications A 67-year-old female presents to the ED after a fall. X-ray confirms a closed, impacted fracture of the proximal femur. She has a history of osteoporosis. Q1. Which of the following best explains why this patient is at increased risk for a hip fracture? A. Increased bone formation due to age B. Inactivity leads to cartilage thickening C. Decreased estrogen accelerates bone resorption D. Overproduction of osteoblasts causes bone fragility Q2. The nurse monitors for which complications? (Select all that apply) A. Fat embolism B. Compartment syndrome C. Osteonecrosis D. Synovitis E. DVT Q3. True or False: Hip fractures are more common in elderly women due to trabecular bone loss and low estrogen levels. Case 2: Compartment Syndrome A 22-year-old male with a tibial fracture in a cast complains of severe pain unrelieved by opioids. Assessment reveals pallor, paresthesia, and diminished pulses. Q4. What is the nurse’s priority intervention? A. Administer morphine B. Reposition the extremity below the heart C. Notify the healthcare provider immediately D. Increase IV fluids Q5. Which findings are consistent with compartment syndrome? (Select all that apply) A. Paralysis B. Cold, pulseless extremity C. Bounding pedal pulses D. Tingling and numbness E. Cyanotic lips Case 3: Osteoporosis A 70-year-old woman is diagnosed with osteoporosis. She reports back pain and height loss. Q6. What is the underlying pathophysiology of osteoporosis? A. Excessive osteoblast activity B. Increased calcium absorption in the GI tract C. Greater bone resorption than bone formation D. Thickening of trabecular bone Q7. Which interventions are appropriate for this patient? (Select all that apply) A. Vitamin D supplementation B. Encourage high-impact aerobics C. Fall prevention measures D. Bisphosphonate therapy E. Encourage bedrest to prevent injury Q8. True or False: Osteoporosis can be detected early through symptoms such as joint pain and inflammation. Case 4: Osteoarthritis (OA) A 58-year-old patient presents with right knee pain, morning stiffness for 20 minutes, and crepitus with movement. Q9. What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Gout D. Osteomyelitis Q10. Which statements about OA are true? (Select all that apply) A. It affects weight-bearing joints B. It is an autoimmune disease C. Bouchard and Heberden nodes may be present D. Joint pain improves with movement E. It typically presents with systemic symptoms Case 5: Rheumatoid Arthritis A 46-year-old female presents with fatigue, joint stiffness in the morning lasting 1 hour, and symmetrical swelling of both wrists. Labs reveal positive rheumatoid factor (RF). Q11. What is the pathophysiology of RA? A. Antigen-antibody complexes form in cartilage B. Destruction of bone due to uric acid crystals C. Autoantibodies attack the synovium D. Infection spreads from the lungs to the joints Q12. True or False: RA typically presents asymmetrically and affects larger joints only. Case 6: Osteomyelitis A 10-year-old boy with fever and leg pain is diagnosed with acute osteomyelitis. Q13. Which pathophysiologic process occurs in osteomyelitis? A. Bone remodeling accelerates B. Infection leads to abscess formation and necrosis C. Autoantibodies destroy bone tissue D. Myelin sheaths of bone nerves are damaged Q14. What clinical manifestations would you expect? (Select all that apply) A. High fever B. Muscle spasm C. Weight gain D. Local redness and swelling E. Excessive urination Case 7: Gout A 55-year-old male presents with severe pain, redness, and swelling in the right big toe. Uric acid is elevated. Q15. What is the hallmark pathophysiology of gout? A. Calcium deposits in the joints B. Hyperuricemia and urate crystal deposition C. Overactive osteoblasts causing inflammation D. Vitamin D deficiency Q16. Which are known triggers of acute gout attacks? (Select all that apply) A. Alcohol B. Starvation C. Diuretics D. Corticosteroids E. High-purine foods Case 8: Myasthenia Gravis A 35-year-old woman presents with drooping eyelids and increasing muscle fatigue with activity. Q17. Which neurotransmitter is affected in Myasthenia Gravis? A. Dopamine B. Norepinephrine C. Acetylcholine D. Serotonin Q18. What is the cause of muscle weakness in Myasthenia Gravis? A. Overactive acetylcholine production B. Acetylcholine receptor destruction by autoantibodies C. Inflammation of skeletal muscle D. Decrease in nerve conduction speed Q19. True or False: Symptoms of Myasthenia Gravis improve with exercise and worsen with rest. Case 9: Duchenne Muscular Dystrophy A 5-year-old boy has enlarged calf muscles, frequent falls, and difficulty rising from the floor. Q20. What is the most likely cause? A. Vitamin D deficiency B. Duchenne Muscular Dystrophy due to dystrophin deficiency C. Spinal muscular atrophy D. Rickets Case 1: Pediatric Growth Abnormalities A 7-year-old male is brought to the clinic for short stature. His parents report he has not been growing like his peers and note delayed dental eruption. 1. Based on the clinical picture, which diagnosis is most likely? A. Gigantism B. Acromegaly C. Growth Hormone Deficiency D. Hyperthyroidism 2. Which of the following findings would support Growth Hormone Deficiency? (Select all that apply) A. Thin hair and poor nails B. Normal birth weight and length C. Delayed puberty D. Exophthalmos E. Hypoglycemia Case 2: Endocrine Emergency A 65-year-old woman presents with altered mental status, hypothermia, and hypotension. Family reports recent withdrawal from thyroid medication. 3. What is the most likely diagnosis? A. Thyroid storm B. SIADH C. Myxedema coma D. Addisonian crisis 4. What is the immediate nursing priority? A. Administer IV thyroid hormone replacement B. Begin rapid re-warming C. Administer insulin D. Monitor for fluid overload 5. True or False: Rewarming is contraindicated in myxedema coma. Case 3: ADH Disturbance A patient with a history of head trauma presents with excessive urination, thirst, and dehydration. Labs show hypernatremia and low urine specific gravity. 6. Which condition is most consistent with this clinical picture? A. Diabetes mellitus B. SIADH C. Diabetes insipidus D. Addison’s disease 7. Which laboratory findings are consistent with Diabetes Insipidus? (Select all that apply) A. Hypernatremia B. Increased serum osmolality C. Decreased BUN D. High urine specific gravity E. Polyuria Case 4: Thyroid Storm A 35-year-old woman with untreated Graves’ disease presents to the ER with fever, palpitations, and confusion. Vitals show a HR of 155 bpm and a temperature of 104°F. 8. What is the best initial treatment action? A. Administer IV hydrocortisone B. Prepare for surgical thyroidectomy C. Administer beta-blockers D. Encourage fluid restriction 9. True or False: Thyroid storm is characterized by bradycardia and hypothermia. Case 5: Adrenal Disorders A 45-year-old man presents with severe hypotension, weakness, and hyperpigmented skin folds. He reports stopping corticosteroids abruptly. 10. What is the likely diagnosis? A. Cushing disease B. Addison disease C. Acromegaly D. SIADH 11. What is the most appropriate immediate intervention? A. Start fluid restriction B. Administer beta-blockers C. Give IV glucocorticoids D. Start oral levothyroxine Case 6: Parathyroid Crisis A 60-year-old patient who had recent thyroid surgery presents with perioral numbness, hand spasms, and a positive Chvostek sign. 12. What condition is suspected? A. Hyperparathyroidism B. Cushing syndrome C. Hypoparathyroidism D. Graves’ disease 13. What is the expected calcium and phosphorus profile? A. ↑ Calcium, ↓ Phosphorus B. ↓ Calcium, ↑ Phosphorus C. ↑ Calcium, ↑ Phosphorus D. ↓ Calcium, ↓ Phosphorus 14. What is the priority nursing action? A. Administer IV insulin B. Give oral vitamin D C. Administer IV calcium D. Start beta-blockers Case 7: Hyperthyroidism A patient presents with weight loss, heat intolerance, tachycardia, and exophthalmos. Labs show suppressed TSH and elevated T3 and T4. 15. What is the likely diagnosis? A. Hypothyroidism B. Cushing syndrome C. Graves’ disease D. Myxedema 16. Which of the following is a hallmark sign of Graves’ disease? A. Moon face B. Bradycardia C. Exophthalmos D. Cold intolerance Case 8: Cushing Syndrome A patient presents with a round face, abdominal obesity, thin extremities, and purple striae on the abdomen. 17. What lab values would be expected in Cushing syndrome? (Select all that apply) A. Hyperglycemia B. Hypokalemia C. Low cortisol D. Elevated ACTH E. Elevated calcium 18. What are appropriate treatments for Cushing disease? (Select all that apply) A. Steroid withdrawal B. Pituitary surgery C. Beta-blockers D. Glucocorticoid replacement E. Laser ablation Case 9: Pheochromocytoma A 39-year-old woman presents with episodic hypertension, palpitations, and sweating. 19. What is the most likely diagnosis? A. SIADH B. Pheochromocytoma C. Addison’s disease D. Graves’ disease 20. What is the definitive treatment? A. Calcium infusion B. IV glucocorticoids C. Surgical removal of tumor D. Long-term steroids 1.