NSG 341 FINAL EXAM NEWEST ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
|ALREADY GRADED A+(REAL DEAL)
Question 1
A patient with type 1 diabetes presents to the emergency department with sweating, shakiness,
and anxiety. The fingerstick blood glucose is 58 mg/dL. These findings are recognized as:
A) Early signs of hyperglycemia
B) Late signs of hypoglycemia
C) Early signs of hypoglycemia
D) Late signs of diabetic ketoacidosis (DKA)
Correct Answer: C) Early signs of hypoglycemia
Rationale: The body's initial response to low blood glucose (hypoglycemia) is the activation of
the sympathetic nervous system, releasing epinephrine and norepinephrine. This causes the
classic adrenergic symptoms of sweating (diaphoresis), shakiness (tremors), and anxiety.
Question 2
A nurse is assessing a patient with a history of diabetes who is unresponsive. The family reports
the patient has been ill and not eating well. Which finding would be most consistent with a late
sign of severe hypoglycemia?
A) Extreme thirst and urination
B) Fruity-scented breath
C) Kussmaul respirations
D) Coma and seizures
Correct Answer: D) Coma and seizures
Rationale: As hypoglycemia worsens, the brain is deprived of its primary energy source,
glucose. This leads to severe neuroglycopenic symptoms, which include altered mental status,
confusion, seizures, loss of consciousness, and eventually, coma and death if left untreated.
Question 3
A patient is newly diagnosed with type 2 diabetes. The nurse teaches the patient about the
signs of hyperglycemia. Which signs should be included as early indicators of high blood
,glucose?
A) Polyuria, polydipsia, and fatigue
B) Sweating, hunger, and shakiness
C) Cool, clammy skin and confusion
D) Bradycardia and hypotension
Correct Answer: A) Polyuria, polydipsia, and fatigue
Rationale: In hyperglycemia, high levels of glucose in the blood act as an osmotic diuretic,
causing the kidneys to excrete more water (polyuria). This water loss leads to dehydration and
intense thirst (polydipsia). Additionally, the body's cells are unable to use the glucose for
energy, resulting in profound fatigue.
Question 4
A nursing student asks how insulin works to regulate glucose metabolism. What is the nurse's
best response?
A) "Insulin stimulates the liver to convert glycogen into glucose, raising blood sugar."
B) "Insulin acts like a key to allow glucose to move from the blood into the cells for energy."
C) "Insulin helps the kidneys reabsorb glucose so it is not lost in the urine."
D) "Insulin breaks down glucose in the bloodstream before it can enter the cells."
Correct Answer: B) "Insulin acts like a key to allow glucose to move from the blood into the
cells for energy."
Rationale: Insulin binds to receptors on the surface of body cells (especially muscle, liver, and
fat cells), which activates glucose transport proteins (like GLUT4). This allows glucose to be
transported from the bloodstream into the cell, where it can be used for energy, thus
lowering blood glucose levels.
Question 5
When providing "sick day" management instructions to a patient with type 1 diabetes, which
statement is most important for the nurse to include?
A) "Skip your insulin if you are not eating so your blood sugar doesn't go too low."
B) "Test your blood glucose every 8 hours and drink plenty of diet soda."
C) "Continue taking your insulin as prescribed and check your blood glucose more frequently, at
,least every 4 hours."
D) "Stop all medications and contact your provider immediately if you feel ill."
Correct Answer: C) "Continue taking your insulin as prescribed and check your blood glucose
more frequently, at least every 4 hours."
Rationale: During illness, the body releases stress hormones which can raise blood glucose
levels, even if the patient is not eating. It is crucial for the patient to continue their insulin
regimen to prevent diabetic ketoacidosis (DKA). They should monitor their glucose and
ketones more frequently and stay well-hydrated.
Question 6
A patient with type 1 diabetes is prescribed insulin glargine (Lantus). What is the most
important information the nurse should teach the patient about this type of insulin?
A) "This is a rapid-acting insulin that you should take right before your meals."
B) "This insulin has a peak effect in 2-4 hours, so you should have a snack ready."
C) "This is a long-acting insulin that provides steady coverage and has no pronounced peak."
D) "You can mix this insulin in the same syringe with your regular insulin."
Correct Answer: C) "This is a long-acting insulin that provides steady coverage and has no
pronounced peak."
Rationale: Insulin glargine is a long-acting basal insulin designed to be released slowly over a
24-hour period. It does not have a significant peak, which helps to control blood glucose
levels between meals and overnight and reduces the risk of hypoglycemia. It should never be
mixed with other insulins.
Question 7
A patient is admitted with diabetic ketoacidosis (DKA). The nurse would expect the initial
laboratory results to show which of the following?
A) Hypoglycemia, metabolic alkalosis, and hypokalemia
B) Hyperglycemia, metabolic acidosis, and presence of ketones
C) Normal blood glucose, respiratory acidosis, and hyperkalemia
D) Hypoglycemia, respiratory alkalosis, and absence of ketones
Correct Answer: B) Hyperglycemia, metabolic acidosis, and presence of ketones
, Rationale: DKA is a triad of hyperglycemia (BG >250 mg/dL), metabolic acidosis (pH <7.3,
Bicarb <18), and ketonemia/ketonuria. The lack of insulin leads to uncontrolled glucose
production and the breakdown of fats for energy, producing acidic ketone bodies.
Question 8
What is the primary difference between Diabetic Ketoacidosis (DKA) and Hyperosmolar
Hyperglycemic State (HHS)?
A) DKA occurs in type 2 diabetics, while HHS occurs in type 1.
B) Blood glucose levels are typically much lower in HHS than in DKA.
C) The primary problem in HHS is ketosis, while in DKA it is dehydration.
D) Significant ketosis and acidosis are present in DKA, but absent or minimal in HHS.
Correct Answer: D) Significant ketosis and acidosis are present in DKA, but absent or minimal
in HHS.
Rationale: HHS is primarily a state of profound dehydration due to extremely high blood
glucose levels (often >600 mg/dL). Patients with HHS (typically type 2 DM) have enough
circulating insulin to prevent the significant fat breakdown that leads to ketoacidosis, which is
the hallmark of DKA (typically type 1 DM).
Question 9
A patient with hypoglycemia is conscious and able to swallow. According to the "15-15 rule,"
what is the nurse's priority action?
A) Administer 1 mg of glucagon intramuscularly.
B) Administer 15 grams of a simple carbohydrate.
C) Administer 15 units of regular insulin subcutaneously.
D) Provide a meal containing 15 grams of protein and fat.
Correct Answer: B) Administer 15 grams of a simple carbohydrate.
Rationale: The "15-15 rule" for treating mild to moderate hypoglycemia is to provide 15 grams
of a fast-acting carbohydrate (e.g., 4 oz of juice, glucose tablets), wait 15 minutes, and then
recheck the blood glucose. This is repeated until the blood glucose is above 70 mg/dL.
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
|ALREADY GRADED A+(REAL DEAL)
Question 1
A patient with type 1 diabetes presents to the emergency department with sweating, shakiness,
and anxiety. The fingerstick blood glucose is 58 mg/dL. These findings are recognized as:
A) Early signs of hyperglycemia
B) Late signs of hypoglycemia
C) Early signs of hypoglycemia
D) Late signs of diabetic ketoacidosis (DKA)
Correct Answer: C) Early signs of hypoglycemia
Rationale: The body's initial response to low blood glucose (hypoglycemia) is the activation of
the sympathetic nervous system, releasing epinephrine and norepinephrine. This causes the
classic adrenergic symptoms of sweating (diaphoresis), shakiness (tremors), and anxiety.
Question 2
A nurse is assessing a patient with a history of diabetes who is unresponsive. The family reports
the patient has been ill and not eating well. Which finding would be most consistent with a late
sign of severe hypoglycemia?
A) Extreme thirst and urination
B) Fruity-scented breath
C) Kussmaul respirations
D) Coma and seizures
Correct Answer: D) Coma and seizures
Rationale: As hypoglycemia worsens, the brain is deprived of its primary energy source,
glucose. This leads to severe neuroglycopenic symptoms, which include altered mental status,
confusion, seizures, loss of consciousness, and eventually, coma and death if left untreated.
Question 3
A patient is newly diagnosed with type 2 diabetes. The nurse teaches the patient about the
signs of hyperglycemia. Which signs should be included as early indicators of high blood
,glucose?
A) Polyuria, polydipsia, and fatigue
B) Sweating, hunger, and shakiness
C) Cool, clammy skin and confusion
D) Bradycardia and hypotension
Correct Answer: A) Polyuria, polydipsia, and fatigue
Rationale: In hyperglycemia, high levels of glucose in the blood act as an osmotic diuretic,
causing the kidneys to excrete more water (polyuria). This water loss leads to dehydration and
intense thirst (polydipsia). Additionally, the body's cells are unable to use the glucose for
energy, resulting in profound fatigue.
Question 4
A nursing student asks how insulin works to regulate glucose metabolism. What is the nurse's
best response?
A) "Insulin stimulates the liver to convert glycogen into glucose, raising blood sugar."
B) "Insulin acts like a key to allow glucose to move from the blood into the cells for energy."
C) "Insulin helps the kidneys reabsorb glucose so it is not lost in the urine."
D) "Insulin breaks down glucose in the bloodstream before it can enter the cells."
Correct Answer: B) "Insulin acts like a key to allow glucose to move from the blood into the
cells for energy."
Rationale: Insulin binds to receptors on the surface of body cells (especially muscle, liver, and
fat cells), which activates glucose transport proteins (like GLUT4). This allows glucose to be
transported from the bloodstream into the cell, where it can be used for energy, thus
lowering blood glucose levels.
Question 5
When providing "sick day" management instructions to a patient with type 1 diabetes, which
statement is most important for the nurse to include?
A) "Skip your insulin if you are not eating so your blood sugar doesn't go too low."
B) "Test your blood glucose every 8 hours and drink plenty of diet soda."
C) "Continue taking your insulin as prescribed and check your blood glucose more frequently, at
,least every 4 hours."
D) "Stop all medications and contact your provider immediately if you feel ill."
Correct Answer: C) "Continue taking your insulin as prescribed and check your blood glucose
more frequently, at least every 4 hours."
Rationale: During illness, the body releases stress hormones which can raise blood glucose
levels, even if the patient is not eating. It is crucial for the patient to continue their insulin
regimen to prevent diabetic ketoacidosis (DKA). They should monitor their glucose and
ketones more frequently and stay well-hydrated.
Question 6
A patient with type 1 diabetes is prescribed insulin glargine (Lantus). What is the most
important information the nurse should teach the patient about this type of insulin?
A) "This is a rapid-acting insulin that you should take right before your meals."
B) "This insulin has a peak effect in 2-4 hours, so you should have a snack ready."
C) "This is a long-acting insulin that provides steady coverage and has no pronounced peak."
D) "You can mix this insulin in the same syringe with your regular insulin."
Correct Answer: C) "This is a long-acting insulin that provides steady coverage and has no
pronounced peak."
Rationale: Insulin glargine is a long-acting basal insulin designed to be released slowly over a
24-hour period. It does not have a significant peak, which helps to control blood glucose
levels between meals and overnight and reduces the risk of hypoglycemia. It should never be
mixed with other insulins.
Question 7
A patient is admitted with diabetic ketoacidosis (DKA). The nurse would expect the initial
laboratory results to show which of the following?
A) Hypoglycemia, metabolic alkalosis, and hypokalemia
B) Hyperglycemia, metabolic acidosis, and presence of ketones
C) Normal blood glucose, respiratory acidosis, and hyperkalemia
D) Hypoglycemia, respiratory alkalosis, and absence of ketones
Correct Answer: B) Hyperglycemia, metabolic acidosis, and presence of ketones
, Rationale: DKA is a triad of hyperglycemia (BG >250 mg/dL), metabolic acidosis (pH <7.3,
Bicarb <18), and ketonemia/ketonuria. The lack of insulin leads to uncontrolled glucose
production and the breakdown of fats for energy, producing acidic ketone bodies.
Question 8
What is the primary difference between Diabetic Ketoacidosis (DKA) and Hyperosmolar
Hyperglycemic State (HHS)?
A) DKA occurs in type 2 diabetics, while HHS occurs in type 1.
B) Blood glucose levels are typically much lower in HHS than in DKA.
C) The primary problem in HHS is ketosis, while in DKA it is dehydration.
D) Significant ketosis and acidosis are present in DKA, but absent or minimal in HHS.
Correct Answer: D) Significant ketosis and acidosis are present in DKA, but absent or minimal
in HHS.
Rationale: HHS is primarily a state of profound dehydration due to extremely high blood
glucose levels (often >600 mg/dL). Patients with HHS (typically type 2 DM) have enough
circulating insulin to prevent the significant fat breakdown that leads to ketoacidosis, which is
the hallmark of DKA (typically type 1 DM).
Question 9
A patient with hypoglycemia is conscious and able to swallow. According to the "15-15 rule,"
what is the nurse's priority action?
A) Administer 1 mg of glucagon intramuscularly.
B) Administer 15 grams of a simple carbohydrate.
C) Administer 15 units of regular insulin subcutaneously.
D) Provide a meal containing 15 grams of protein and fat.
Correct Answer: B) Administer 15 grams of a simple carbohydrate.
Rationale: The "15-15 rule" for treating mild to moderate hypoglycemia is to provide 15 grams
of a fast-acting carbohydrate (e.g., 4 oz of juice, glucose tablets), wait 15 minutes, and then
recheck the blood glucose. This is repeated until the blood glucose is above 70 mg/dL.
