NU 189 / NU189 EXAM 2
2026-2027 |
Medical-Surgical Nursing II
Review | Galen College |
100% Verified Q&A | Grade A |
Pass Guaranteed
## **PART A: MULTIPLE CHOICE (Q1–55)**
* *Q1 (Endocrine – DKA):** A 22-year-old female with type 1 diabetes presents with nausea,
vomiting, deep rapid breathing (Kussmaul), and a blood glucose of 480 mg/dL. Labs: pH 7.20,
HCO3 10, anion gap 22, positive serum ketones. Which IV fluid should be administered first?
A. 0.45% NaCl with 5% dextrose
B. 0.9% NaCl (normal saline)
C. 3% NaCl
D. Dextrose 5% in 0.45% NaCl with insulin
* *[CORRECT]** B
*Rationale: Initial fluid resuscitation in DKA is 0.9% NaCl (normal saline) to restore intravascular
volume and correct hyperosmolality. 0.45% NaCl with dextrose (A) is used later when glucose
falls to ~250 mg/dL to prevent hypoglycemia while continuing insulin. 3% NaCl (C) is reserved
for severe symptomatic hyponatremia. Dextrose (D) is not added initially. Test tip: First = NS;
second = add D5 when glucose hits 250 mg/dL per ADA 2026 guidelines.*
---
* *Q2 (Endocrine – Hypoglycemia):** A 68-year-old with type 2 diabetes on glipizide becomes
confused, diaphoretic, and shaky. Blood glucose is 52 mg/dL. The patient is alert enough to
swallow. What is the nurse's priority action?
A. Administer 1 mg glucagon IM
, . Give 15 g fast-acting carbohydrate
B
C. Start D5W IV at 125 mL/hr
D. Hold the next dose of glipizide and notify provider
* *[CORRECT]** B
*Rationale: The "Rule of 15" states giving 15 g fast-acting carbohydrate (glucose tablets, juice,
regular soda) for conscious patients with blood glucose <70 mg/dL. Glucagon (A) is for
unconscious or NPO patients. IV dextrose (C) is unnecessary if the patient can swallow. Holding
medication (D) is appropriate but not the priority over treating the current hypoglycemia. Clinical
pearl: Recheck glucose in 15 minutes and retreat if still <70.*
---
* *Q3 (Endocrine – Insulin Types):** A patient with type 1 diabetes needs basal insulin coverage
overnight and rapid-acting insulin for mealtime coverage. Which regimen best matches this
need?
A. NPH insulin twice daily only
B. Insulin glargine (Lantus) once daily + insulin lispro (Humalog) with meals
C. Regular insulin (Humulin R) three times daily before meals
D. Insulin detemir (Levemir) once daily only
* *[CORRECT]** B
*Rationale: Basal-bolus therapy uses long-acting insulin (glargine, detemir, degludec) for basal
coverage and rapid-acting insulin (lispro, aspart, glulisine) for prandial coverage. NPH (A) is
intermediate-acting with peak effects and hypoglycemia risk. Regular insulin (C) is short-acting,
not rapid-acting. Detemir alone (D) provides no mealtime coverage. ADA 2026 recommends
basal-bolus or pump therapy for type 1 diabetes.*
---
* *Q4 (Endocrine – SGLT2 Inhibitors):** A patient with type 2 diabetes and heart failure with
reduced ejection fraction (HFrEF) is prescribed empagliflozin (Jardiance). Which teaching point
is most important for the nurse to include?
A. "Take this medication 30 minutes before meals for best absorption."
B. "You may notice increased urination and a higher risk of genital yeast infections."
C. "If you miss a dose, double the next dose to maintain blood sugar control."
D. "This medication will completely replace your need for insulin."
* *[CORRECT]** B
*Rationale: SGLT2 inhibitors increase urinary glucose excretion, causing osmotic diuresis
(increased urination) and creating a favorable environment for genital mycotic infections. They
are taken once daily regardless of meals (A is wrong). Never double doses (C). They are
adjunctive therapy, not a replacement for insulin in type 1 diabetes or advanced type 2 (D).
ADA/AHA 2026: SGLT2 inhibitors have proven cardiovascular and renal benefits in HFrEF.*
,---
* *Q5 (Endocrine – Thyroid – Hyperthyroidism):** A 32-year-old with Graves' disease is
prescribed methimazole. Which assessment finding indicates the medication is effective?
A. Weight gain of 5 lb in one week
B. Decreased heart rate from 110 to 78 bpm
C. Development of exophthalmos
D. Increased heat intolerance
* *[CORRECT]** B
*Rationale: Methimazole blocks thyroid hormone synthesis. A decreased heart rate indicates
reduced thyroid hormone effect on the cardiovascular system. Weight gain (A) may occur but 5
lb in one week suggests fluid retention, not therapeutic effect. Exophthalmos (C) is an
autoimmune manifestation not reversed by antithyroid drugs. Increased heat intolerance (D)
indicates worsening hyperthyroidism. Monitor for agranulocytosis (fever, sore throat) with
methimazole.*
---
* *Q6 (Endocrine – Thyroid – Hypothyroidism):** A patient with newly diagnosed hypothyroidism
is started on levothyroxine. Which instruction is most important?
A. "Take the medication with your morning coffee and breakfast."
B. "Take on an empty stomach 30–60 minutes before breakfast with water."
C. "Take at bedtime with a high-fiber snack."
D. "Crush the tablet and mix with applesauce if you have trouble swallowing."
* *[CORRECT]** B
*Rationale: Levothyroxine absorption is impaired by food, coffee, calcium, iron, and fiber. It must
be taken on an empty stomach with water, 30–60 minutes before breakfast or 3–4 hours after
the last meal. Coffee and breakfast (A) reduce absorption. High-fiber snacks (C) decrease
absorption. Levothyroxine tablets should not be crushed (D); use liquid formulation if needed.
TSH should be rechecked in 6–8 weeks.*
---
* *Q7 (Endocrine – Addison's Disease):** A patient with Addison's disease presents with
confusion, severe hypotension (82/48 mmHg), hyperkalemia (6.2 mEq/L), and hyponatremia
(128 mEq/L). What is the priority nursing intervention?
A. Administer IV hydrocortisone and 0.9% NaCl immediately
B. Start potassium-wasting diuretics
C. Administer levothyroxine IV push
D. Give oral fludrocortisone and monitor for 24 hours
, * *[CORRECT]** A
*Rationale: This patient is in Addisonian crisis (acute adrenal insufficiency) requiring immediate
IV hydrocortisone (glucocorticoid replacement) and isotonic saline for volume resuscitation.
Diuretics (B) worsen hypotension. Levothyroxine (C) treats hypothyroidism, not adrenal crisis.
Oral medications (D) are inappropriate in hemodynamic instability. Addison's disease causes
hyperpigmentation, hypotension, hyponatremia, and hyperkalemia due to aldosterone
deficiency.*
---
* *Q8 (Endocrine – Cushing's Syndrome):** A patient with Cushing's syndrome is at highest risk
for which complication?
A. Hypoglycemia and weight loss
B. Hyperglycemia, hypertension, and osteoporosis
C. Bradycardia and hypothermia
D. Hyponatremia and hyperkalemia
* *[CORRECT]** B
*Rationale: Cushing's syndrome (cortisol excess) causes hyperglycemia (gluconeogenesis),
hypertension (sodium/water retention), and osteoporosis (bone resorption). Weight gain (not
loss) and tachycardia (not bradycardia) are typical. Hyponatremia and hyperkalemia (D) occur in
Addison's disease, not Cushing's. Nursing priorities include glucose monitoring, blood pressure
management, fall prevention, and infection surveillance.*
---
* *Q9 (Endocrine – HHS):** A 78-year-old with type 2 diabetes is admitted with HHS. Blood
glucose is 920 mg/dL, serum osmolality 340 mOsm/kg, pH 7.35, and absent ketones. Which
statement about management is correct?
A. An insulin drip should be started before fluid resuscitation
B. 0.9% NaCl is the initial fluid of choice, with insulin started after volume expansion
C. DKA and HHS are managed identically with the same fluid protocols
D. Potassium replacement should begin before any fluids are administered
* *[CORRECT]** B
*Rationale: HHS management prioritizes aggressive fluid resuscitation with 0.9% NaCl first;
insulin is started after initial volume expansion because rapid insulin without fluids can worsen
hypotension. DKA and HHS differ: HHS has no ketosis, higher glucose/osmolality, and typically
requires more fluid replacement. Potassium (D) is monitored and replaced based on levels but
not before fluids. Test tip: HHS = more fluid, less insulin urgency than DKA.*
---
2026-2027 |
Medical-Surgical Nursing II
Review | Galen College |
100% Verified Q&A | Grade A |
Pass Guaranteed
## **PART A: MULTIPLE CHOICE (Q1–55)**
* *Q1 (Endocrine – DKA):** A 22-year-old female with type 1 diabetes presents with nausea,
vomiting, deep rapid breathing (Kussmaul), and a blood glucose of 480 mg/dL. Labs: pH 7.20,
HCO3 10, anion gap 22, positive serum ketones. Which IV fluid should be administered first?
A. 0.45% NaCl with 5% dextrose
B. 0.9% NaCl (normal saline)
C. 3% NaCl
D. Dextrose 5% in 0.45% NaCl with insulin
* *[CORRECT]** B
*Rationale: Initial fluid resuscitation in DKA is 0.9% NaCl (normal saline) to restore intravascular
volume and correct hyperosmolality. 0.45% NaCl with dextrose (A) is used later when glucose
falls to ~250 mg/dL to prevent hypoglycemia while continuing insulin. 3% NaCl (C) is reserved
for severe symptomatic hyponatremia. Dextrose (D) is not added initially. Test tip: First = NS;
second = add D5 when glucose hits 250 mg/dL per ADA 2026 guidelines.*
---
* *Q2 (Endocrine – Hypoglycemia):** A 68-year-old with type 2 diabetes on glipizide becomes
confused, diaphoretic, and shaky. Blood glucose is 52 mg/dL. The patient is alert enough to
swallow. What is the nurse's priority action?
A. Administer 1 mg glucagon IM
, . Give 15 g fast-acting carbohydrate
B
C. Start D5W IV at 125 mL/hr
D. Hold the next dose of glipizide and notify provider
* *[CORRECT]** B
*Rationale: The "Rule of 15" states giving 15 g fast-acting carbohydrate (glucose tablets, juice,
regular soda) for conscious patients with blood glucose <70 mg/dL. Glucagon (A) is for
unconscious or NPO patients. IV dextrose (C) is unnecessary if the patient can swallow. Holding
medication (D) is appropriate but not the priority over treating the current hypoglycemia. Clinical
pearl: Recheck glucose in 15 minutes and retreat if still <70.*
---
* *Q3 (Endocrine – Insulin Types):** A patient with type 1 diabetes needs basal insulin coverage
overnight and rapid-acting insulin for mealtime coverage. Which regimen best matches this
need?
A. NPH insulin twice daily only
B. Insulin glargine (Lantus) once daily + insulin lispro (Humalog) with meals
C. Regular insulin (Humulin R) three times daily before meals
D. Insulin detemir (Levemir) once daily only
* *[CORRECT]** B
*Rationale: Basal-bolus therapy uses long-acting insulin (glargine, detemir, degludec) for basal
coverage and rapid-acting insulin (lispro, aspart, glulisine) for prandial coverage. NPH (A) is
intermediate-acting with peak effects and hypoglycemia risk. Regular insulin (C) is short-acting,
not rapid-acting. Detemir alone (D) provides no mealtime coverage. ADA 2026 recommends
basal-bolus or pump therapy for type 1 diabetes.*
---
* *Q4 (Endocrine – SGLT2 Inhibitors):** A patient with type 2 diabetes and heart failure with
reduced ejection fraction (HFrEF) is prescribed empagliflozin (Jardiance). Which teaching point
is most important for the nurse to include?
A. "Take this medication 30 minutes before meals for best absorption."
B. "You may notice increased urination and a higher risk of genital yeast infections."
C. "If you miss a dose, double the next dose to maintain blood sugar control."
D. "This medication will completely replace your need for insulin."
* *[CORRECT]** B
*Rationale: SGLT2 inhibitors increase urinary glucose excretion, causing osmotic diuresis
(increased urination) and creating a favorable environment for genital mycotic infections. They
are taken once daily regardless of meals (A is wrong). Never double doses (C). They are
adjunctive therapy, not a replacement for insulin in type 1 diabetes or advanced type 2 (D).
ADA/AHA 2026: SGLT2 inhibitors have proven cardiovascular and renal benefits in HFrEF.*
,---
* *Q5 (Endocrine – Thyroid – Hyperthyroidism):** A 32-year-old with Graves' disease is
prescribed methimazole. Which assessment finding indicates the medication is effective?
A. Weight gain of 5 lb in one week
B. Decreased heart rate from 110 to 78 bpm
C. Development of exophthalmos
D. Increased heat intolerance
* *[CORRECT]** B
*Rationale: Methimazole blocks thyroid hormone synthesis. A decreased heart rate indicates
reduced thyroid hormone effect on the cardiovascular system. Weight gain (A) may occur but 5
lb in one week suggests fluid retention, not therapeutic effect. Exophthalmos (C) is an
autoimmune manifestation not reversed by antithyroid drugs. Increased heat intolerance (D)
indicates worsening hyperthyroidism. Monitor for agranulocytosis (fever, sore throat) with
methimazole.*
---
* *Q6 (Endocrine – Thyroid – Hypothyroidism):** A patient with newly diagnosed hypothyroidism
is started on levothyroxine. Which instruction is most important?
A. "Take the medication with your morning coffee and breakfast."
B. "Take on an empty stomach 30–60 minutes before breakfast with water."
C. "Take at bedtime with a high-fiber snack."
D. "Crush the tablet and mix with applesauce if you have trouble swallowing."
* *[CORRECT]** B
*Rationale: Levothyroxine absorption is impaired by food, coffee, calcium, iron, and fiber. It must
be taken on an empty stomach with water, 30–60 minutes before breakfast or 3–4 hours after
the last meal. Coffee and breakfast (A) reduce absorption. High-fiber snacks (C) decrease
absorption. Levothyroxine tablets should not be crushed (D); use liquid formulation if needed.
TSH should be rechecked in 6–8 weeks.*
---
* *Q7 (Endocrine – Addison's Disease):** A patient with Addison's disease presents with
confusion, severe hypotension (82/48 mmHg), hyperkalemia (6.2 mEq/L), and hyponatremia
(128 mEq/L). What is the priority nursing intervention?
A. Administer IV hydrocortisone and 0.9% NaCl immediately
B. Start potassium-wasting diuretics
C. Administer levothyroxine IV push
D. Give oral fludrocortisone and monitor for 24 hours
, * *[CORRECT]** A
*Rationale: This patient is in Addisonian crisis (acute adrenal insufficiency) requiring immediate
IV hydrocortisone (glucocorticoid replacement) and isotonic saline for volume resuscitation.
Diuretics (B) worsen hypotension. Levothyroxine (C) treats hypothyroidism, not adrenal crisis.
Oral medications (D) are inappropriate in hemodynamic instability. Addison's disease causes
hyperpigmentation, hypotension, hyponatremia, and hyperkalemia due to aldosterone
deficiency.*
---
* *Q8 (Endocrine – Cushing's Syndrome):** A patient with Cushing's syndrome is at highest risk
for which complication?
A. Hypoglycemia and weight loss
B. Hyperglycemia, hypertension, and osteoporosis
C. Bradycardia and hypothermia
D. Hyponatremia and hyperkalemia
* *[CORRECT]** B
*Rationale: Cushing's syndrome (cortisol excess) causes hyperglycemia (gluconeogenesis),
hypertension (sodium/water retention), and osteoporosis (bone resorption). Weight gain (not
loss) and tachycardia (not bradycardia) are typical. Hyponatremia and hyperkalemia (D) occur in
Addison's disease, not Cushing's. Nursing priorities include glucose monitoring, blood pressure
management, fall prevention, and infection surveillance.*
---
* *Q9 (Endocrine – HHS):** A 78-year-old with type 2 diabetes is admitted with HHS. Blood
glucose is 920 mg/dL, serum osmolality 340 mOsm/kg, pH 7.35, and absent ketones. Which
statement about management is correct?
A. An insulin drip should be started before fluid resuscitation
B. 0.9% NaCl is the initial fluid of choice, with insulin started after volume expansion
C. DKA and HHS are managed identically with the same fluid protocols
D. Potassium replacement should begin before any fluids are administered
* *[CORRECT]** B
*Rationale: HHS management prioritizes aggressive fluid resuscitation with 0.9% NaCl first;
insulin is started after initial volume expansion because rapid insulin without fluids can worsen
hypotension. DKA and HHS differ: HHS has no ketosis, higher glucose/osmolality, and typically
requires more fluid replacement. Potassium (D) is monitored and replaced based on levels but
not before fluids. Test tip: HHS = more fluid, less insulin urgency than DKA.*
---
