NURS 120 – Introduction to Medical Surgical
Nursing (WCU) | Quiz 4 | 2026/2027 Update |
Verified Questions & Answers
Question 1
A client with type 1 diabetes presents with blood glucose 350 mg/dL, arterial pH 7.25, serum
bicarbonate 15 mEq/L, and moderate ketones in urine. This client is most likely experiencing:
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Dawn phenomenon
Answer: B
Rationale: DKA is characterized by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.30,
bicarbonate <18 mEq/L), and ketonemia/ketonuria. It occurs primarily in type 1 diabetes due to
absolute insulin deficiency. HHS typically has much higher glucose (>600 mg/dL), no significant
ketones, and pH >7.30.
Question 2
Which finding best differentiates hyperosmolar hyperglycemic state (HHS) from diabetic
ketoacidosis (DKA)?
A. Blood glucose >600 mg/dL
B. Serum osmolality >320 mOsm/kg with absent/minimal ketones
C. Kussmaul respirations
D. Arterial pH <7.30
Answer: B
Rationale: HHS is seen more often in type 2 diabetes, presents with profound dehydration and
hyperosmolality (>320 mOsm/kg), glucose often >600–1000 mg/dL, and minimal or no ketones
(some insulin present prevents significant lipolysis).
Question 3
The priority intervention for a client in DKA is:
A. Administering bicarbonate IV
, B. Rapid administration of D50W
C. IV fluid resuscitation with 0.9% NaCl
D. Immediate subcutaneous NPH insulin
Answer: C
Rationale: Severe dehydration (up to 10–15 L deficit) is life-threatening in DKA/HHS. Initial
treatment is aggressive IV isotonic saline (0.9% NaCl) at 1 L/hour (adjusted for cardiac/renal
status) to restore perfusion before insulin therapy.
Question 4
When initiating IV regular insulin infusion for DKA, the nurse expects the blood glucose to drop
no faster than:
A. 10–20 mg/dL per hour
B. 50–75 mg/dL per hour
C. 100–150 mg/dL per hour
D. 200 mg/dL per hour
Answer: B
Rationale: Current guidelines (ADA 2025–2026) recommend glucose reduction of 50–75 mg/dL
per hour to avoid cerebral edema and rapid shifts in osmolality.
Question 5
A client with DKA has serum potassium of 3.2 mEq/L after 4 hours of treatment. The nurse
should:
A. Continue current therapy; total-body potassium is high
B. Hold insulin until potassium >5.0 mEq/L
C. Administer potassium supplementation as ordered
D. Notify provider to discontinue all IV fluids
Answer: C
Rationale: Insulin drives potassium intracellularly, unmasking total-body potassium deficit
despite initial hyperkalemia from acidosis. Potassium replacement is routine once level <5.2
mEq/L.
Question 6
Which laboratory result is consistent with hyperthyroidism?
A. TSH 0.01 μU/mL (low), Free T4 3.2 ng/dL (high)
B. TSH 8.5 μU/mL (high), Free T4 0.5 ng/dL (low)
Nursing (WCU) | Quiz 4 | 2026/2027 Update |
Verified Questions & Answers
Question 1
A client with type 1 diabetes presents with blood glucose 350 mg/dL, arterial pH 7.25, serum
bicarbonate 15 mEq/L, and moderate ketones in urine. This client is most likely experiencing:
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Dawn phenomenon
Answer: B
Rationale: DKA is characterized by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.30,
bicarbonate <18 mEq/L), and ketonemia/ketonuria. It occurs primarily in type 1 diabetes due to
absolute insulin deficiency. HHS typically has much higher glucose (>600 mg/dL), no significant
ketones, and pH >7.30.
Question 2
Which finding best differentiates hyperosmolar hyperglycemic state (HHS) from diabetic
ketoacidosis (DKA)?
A. Blood glucose >600 mg/dL
B. Serum osmolality >320 mOsm/kg with absent/minimal ketones
C. Kussmaul respirations
D. Arterial pH <7.30
Answer: B
Rationale: HHS is seen more often in type 2 diabetes, presents with profound dehydration and
hyperosmolality (>320 mOsm/kg), glucose often >600–1000 mg/dL, and minimal or no ketones
(some insulin present prevents significant lipolysis).
Question 3
The priority intervention for a client in DKA is:
A. Administering bicarbonate IV
, B. Rapid administration of D50W
C. IV fluid resuscitation with 0.9% NaCl
D. Immediate subcutaneous NPH insulin
Answer: C
Rationale: Severe dehydration (up to 10–15 L deficit) is life-threatening in DKA/HHS. Initial
treatment is aggressive IV isotonic saline (0.9% NaCl) at 1 L/hour (adjusted for cardiac/renal
status) to restore perfusion before insulin therapy.
Question 4
When initiating IV regular insulin infusion for DKA, the nurse expects the blood glucose to drop
no faster than:
A. 10–20 mg/dL per hour
B. 50–75 mg/dL per hour
C. 100–150 mg/dL per hour
D. 200 mg/dL per hour
Answer: B
Rationale: Current guidelines (ADA 2025–2026) recommend glucose reduction of 50–75 mg/dL
per hour to avoid cerebral edema and rapid shifts in osmolality.
Question 5
A client with DKA has serum potassium of 3.2 mEq/L after 4 hours of treatment. The nurse
should:
A. Continue current therapy; total-body potassium is high
B. Hold insulin until potassium >5.0 mEq/L
C. Administer potassium supplementation as ordered
D. Notify provider to discontinue all IV fluids
Answer: C
Rationale: Insulin drives potassium intracellularly, unmasking total-body potassium deficit
despite initial hyperkalemia from acidosis. Potassium replacement is routine once level <5.2
mEq/L.
Question 6
Which laboratory result is consistent with hyperthyroidism?
A. TSH 0.01 μU/mL (low), Free T4 3.2 ng/dL (high)
B. TSH 8.5 μU/mL (high), Free T4 0.5 ng/dL (low)
