Exam 2: NSG 4100/ NSG4100 – Latest 2026/2027 Update – Advanced Medical-Surgical Nursing | Questions and Verified Answers | 100% Elaborated Solutions

Exam 2: NSG 4100/ NSG 4100 – Latest 2026/2027 Update – Advanced Medical-Surgical Nursing | Questions and Verified Answers | 100% Elaborated Solutions 2026 / 2027 Academic Year Q: The nurse is discussing ways to prevent DKA w/ a client newly diagnosed w/ Type 1 DM, which instruction is most important to discuss with the client? a. refer them to the American Diabetes Association b. Take the prescribed insulin even when unable to eat due to illness c. Do not take any OTC meds d. explain the need to get the annual flu and pneumonia vaccines B Q: ED nurse is caring for pt with HHS who has BG of 680 mg/dl. Which question should the nurse ask to determine the cause of acute complications? a. "when was the last time you took your insulin?" b. "when do you have your last meal?" c. "have you had some type of infection lately?" d. "how long have you had diabetes?" C Q: Client w/ a diagnosis of Addisonian crisis is being admitted to the ICU. Which findings will the inter-professional care team focus on? Select all that apply: a. hypotension b. leuocytosis c. hyperkalmeia d. hypercalcemia e. hypernatremia A, C Q: Nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? a. lower the head of the bed b. test drainage for glucose c. obtain culture of drainage d. continue to observe drainage B Q: Nurse is admitting a client who is diagnosed w/ SIADH and has serum sodium of 118 mEq/L. Which physician prescription should the nurse anticipate receiving? Select all that apply: a. Initiate infusion of 3% NaCl b. administer IV furosemide c. Restrict fluids to 800ml over 24hrs d. elevate HOB to high fowler's e. administer a vasopressin antagonist as prescribed A, C, E Q: Nurse performing an assessment on a client w/ pheochromocytoma. Which assessment data would indicate potential complication with this disease? a. urinary output of 50ml/h b. coagulation time of 5 mins c. HR that is 90bpm & irregular d. BUN of 20 mg/dL C Q: Client is to have transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the a. back of mouth b. nose c. sinus channel below right eye d. upper gingival mucosa in the space between the upper gum and lip D Q: Nurse teaches client to report s/s of which potential complication after a hypophysectomy? a. acromegaly b. Cushing's ds c. diabetes mellitus d. hypopituitarism D Q: After pituitary surgery, the nurse should assess the client for a. urine gravity 1.010 b. UO between 1-2L/day c. BG 300 mg/dL d. urine negative for glucose & ketones A Q: Client with type 1 diabetes is admitted to ED w/ recurrent DKA. Current glucose level is 603 w/ moderate bicarbonate levels. The client is drowsy but responds appropriately. Vital signs are BP 90/42, sinus tachycardia 132/min, RR 36/min, temp 102F, & minimal UO. What does the nurse anticipate as the highest priority for the client? a. culture urine, blood, and sputum for bacteria b. start insulin drop following bolus of 7 units of rapid insulin c. start large bore IV access to allow rapid insulin of fluids d. give rapid acting insulin IM while waiting for labs C Q: 19 y/o woman was admitted to ICU following high-velocity MVA in which she sustained a severe closed head injury. Nurse noticed she has been producing a large amount of urine for the past 3 hrs and is becoming tachycardia and hypotensive. The nurse knows that this client needs to be closely monitored for developing which condition? a. Cushing syndrome, which is treated w/ intermittent doses of corticoids b. DI, which is treated w/ antidiuretic hormone (Vasopressin) c. SIADH, which is create w/ ADH d. DM, which is treated w/ basal analog insulin B Q: Client w/ pituitary tumor developed SIADH. Which intervention should the nurse implement? a. assess for dehydration and monitor BG level b. assess for n/v & weigh daily c. monitor potassium level & encourage fluid intake d. administer vasopressin IV and conduct fluid deprivation test B Q: Nurse is admitting a client to the neurological ICU who is postoperative transsphenoidal hypophysectomy. Which data warrants immediate intervention? a. client is alert to name but unable to tell nurse the location b. client has output of 2500ml since surgery and intake of 1000ml c. client vital signs are T 97.6F, P 88, RR 22, BP 130/80 d. client has 3cm amount of dark red drainage on turban dressing B Q: Client diagnosed with HHNS was admitted yesterday w/ BG of 780 mg/dL. Client BG is now 300 mg/dL. Which intervention should the nurse implement? a. increase regular insulin drip b. check the clients urine for ketones c. provide client w/ therapeutic meal d. notify HCP to obtain an order to decrease insulin D Q: Elderly pt is admitted to ICU diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care? a. infuse 0.9% NS intravenously b. administer intermediate-acting insulin c. perform blood glucose checks daily d. monitor ABG results A Q: Client is diagnosed with type II DM is admitted to the ICU with HHNS coma. Which assessment data should the nurse expect the client to exhibit? a. Kussmaul's repirations b. diarrhea c. dry mucous membranes d. ketone breath odor C Q: Client received 10 units of Humulin R, a fast-acting insulin, at 0700. At 1030, the UAP tells the nurse the client has a headache and is acting "funny." Which intervention should the nurse implement first? a. instruct UAP to obtain BG level b. have client drink 8oz of orange juice c. go to client's room and assess client for hypoglycemia d. prepare to administer 1 ampule of 50% dextrose IV C Q: The nurse is discussing macrovascular complications of diabetes with a pt. The nurse would address what topic during this dialogue? a. the need for frequent eye examinations for pt's w/ diabetes b. the fact that pt's with diabetes have an elevated risk for myocardial infarction c. the relationship between kidney function and BG levels d. the need to monitor urine for the presence of albumin B Q: An elderly pt comes to the clinic with her daughter. The pt is a diabetic and is concerned about foot care. The nurse goes over foot care with the pt and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so importance to this pt? a. an elderly pt w/ foot ulcers experiences severe foot pain due to the diabetic polyneuropathy b. avoiding foot ulcers may mean the difference between institutionalization and continued independent living c. hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes d. oral anti-hyperglycemics have the possible adviser effect of decreased circulation to the lower extremities B Q: A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the pt will require further teaching when the pt states what? a. I will not take my insulin on the days when I am sick, but I will certainly check my BG every 2 hours b. if I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day c. I will call the dr if I am not able to keep liquids in my body due to vomiting or diarrhea d. I will call the dr if my BG is over 300 mg/dL or if I have ketones in my urine A Q: A medical nurse is aware of the need to screen specific pt's for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what pt population does hyperosmolar nonketotic syndrome most often occur? a. pt's who are obese and who have no known hx of diabetes b. pt's w/ type 1 diabetes and poor dietary control c. adolescents with type 2 diabetes and sporadic use of antihyperglycemics d. middle-aged or older people with either type 2 diabetes or no known hx of diabetes D Q: Physician has explained to a pt that he has developed diabetic neuropathy in his right foot. Later that day, the pt asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? a. research has shown that diabetic neuropathy is caused by fluctuations in BG that have gone on for years b. the case is not known for sure but it is though to have something to do with ketoacidosis c. the cause is not known for sure but it is thought to involve elevated BG levels over a period of years d. research has shown that diabetic neuropathy is caused by a combination of elevated BG levels and elevated ketone levels C Q: A pt with a hx of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic keto acidosis. The CCU nurse should prioritize what assessment during the pt's initial phase of tx? a. monitoring pt for dysrhythmias b. maintaining and monitoring pt's fluid balance c. assess pt's LOC d. assessing the pt for s/s of venous thromboembolism B Q: The most recent blood work of a pt with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurses most appropriate action? a. teach pt about actions to slow progression of nephropathy b. ensure that pt receives a comprehensive assessment of liver function c. determine whether pt has been using expired insulin d. administer a fluid challenge and have test repeated A Q: A nurse is assessing a pt who has diabetes for the presence of peripheral neuropathy. The nurse should question the pt about what sign or symptom that would suggest the possible development of peripheral neuropathy? a. persistently cold feet b. pain that does not respond to analgesia c. acute pain, unrelieved by rest d. the presence of a tingling sensation D Q: A pt is brought to the ED by paramedics. The pt is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply: a. leukocytosis b. glycosuria c. dehydration d. hypernatremia e. hyperglycemia B, C, D, E Q: A pt has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the pt? a. side-lying (lateral) with one pillow under the head b. head of the bed elevated 30 degrees and no pillows placed under the head c. semi-fowlers with the head supported on two pillows d. supine, with a small roll supporting the neck C Q: A pt with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the pt should prioritize what question when addressing potential complications? a. do you feel any muscle twitches or spasms? b. do you feel flushed or sweaty? c. are you experiencing any dizziness or lightheadedness? d. are you having any pain that seems to be radiating from your bones? A Q: The nurse is caring for a pt with a diagnosis of Addison's Ds. What s/s is most closely associated with this health problem? a. truncal obesity b. HTN c. muscle weakness d. moon face C The nurse is caring for a pt with Addison's ds who is scheduled for d/c. When teaching the pt about hormone replacement therapy, the nurse should address what topic? a. the possibility of precipitous weight gain b. the need for lifelong steroid replacement c. the need to match the daily steroid dose to immediate sx d. the importance of monitoring liver function B A nurse caring for a pt with diabetes insipidus (DI) is reviewing lab results. What is an expected urinalysis finding? a. glucose in urine b. albumin in urine c. highly dilute urine d. leukocytes in urine C The nurse caring for a pt w/ Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow/ What does the nurse explain that this test will involve? a. administration of dexamethasone orally, followed by a plasma cortisol level every hr for 3 hrs b. administration of dexamethasone IV, followed by an x-ray of the adrenal glands c. administration of dexamethasone orally at 11pm, and a plasma cortisol level at 8am the next morning d. administration of dexamethasone IV, followed by a plasma cortisol level 3 hrs after drug admin C You are developing a care plan for a pt w/ Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan? a. risk for injury r/t weakness b. ineffective breathing pattern r/t muscle weakness c. risk for loneliness r/t disturbed body image d. autonomic dysreflexia r/t neurologic changes A The nurse is performing a shift assessment of a pt with aldosteronism. What assessments should the nurse include? Select all that apply: a. urine output b. s/s of venous thromboembolism c. peripheral pulses d. BP e. skin integrity A, D The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids? a. in evening between 4-6pm b. prior to going to sleep at night c. at noon every day d. in morning between 7-8am D A pt presents at the walk-in clinic complaining of diarrhea and vomiting. The pt has a documented hx of adrenal insufficiency. Considering the pt's hx and current sx, the nurse should anticipate that the pt will be instructed to do which of the following? a. increase his intake of sodium until the GI sx improve b. increase his intake of potassium until the GI sx improve c. increase his intake of glucose until GI sx improve d. increase intake of calcium until GI sx improve A When assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the pt's vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see? a. hyperthermia and tachypnea b. HTN and HR changes c. hypotension and hypothermia d. hyperthermia and bradycardia B A pt has retuned to the floor after having a thyroidectomy for thyroid cancer. The Nurs knows that sometimes during thyroid surgery, the parathyroid glands an be injured or removed. What lab finding may be an early indication of parathyroid gland injury or removal? a. hyponatremia b. hypophosphatemia c. hypocalcemia d. hypokalemia C A pt with a diagnosis of syndrome of inappropriate hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a pt with this condition is what? a. risk fo peripheral neurovascular dysfunction b. excess fluid volume c. hypothermia d. ineffective airway clearance B The dr has ordered a fluid deprivation test for a pt suspected of having DI. During the test, the nurse should prioritize what assessments? a. temperature and oxygen saturation b. HR and BP c. breath sounds and bowel sounds d. color, warmth, movement, and sensation of extremities B A pt has been admitted to the CCU w/ a diagnosis of thyroid storm. What interventions should the nurse include in this pt's immediate care? Select all that apply: a. administering diuretics to prevent fluid overload b. administering beta blockers to reduce HR c. administering insulin to reduce BG levels d. applying interventions to reduce temperature e. administering corticosteroids B, D The nurse assessment of a pt w/ thyroidectomy suggests tetany and a review of the most recent blood work corroborate this finding. The nurse should prepare to administer what intervention? a. oral calcium chloride and vitamin D b. IV calcium gluconate c. STAT levothyroxine d. administration of parathyroid hormone (PTH) B Following an Addisonian crisis, a pt's adrenal function has gradually regained. The nurse should ensure that the pt knows about the need for supplementary glucocorticoid therapy in which of the following circumstances? a. episodes of high psychosocial stress b. periods of dehydration c. episodes of physical exertion d. administration of a vaccine A A pt w/ pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following? a. IV abx b. oral antihypertensives c. parenteral nutrition d. IV corticosteroids D A pt is undergoing testing for suspected adrenocorticol insufficiency. The care team should ensure that the pt has been assessed for the most common cause of adrenocorticol insufficiency. What is the most common cause of this health problem? a. therapeutic use of corticosteroids b. pheochromocytoma c. inadequate secretion of ACTH d. adrenal tumor A A pt w/ Cushing syndrome has been hospitalized after a fall. The dietician consulted works w/ the pt to improve the pt's nutritional intake. What foods should a pt w/ Cushing syndrome eat to optimize health? Select all that apply: a. foods high in vitamin D b. foods high in calories c. foods high in protein d. foods high in calcium e. foods high in sodium A, C, D A pt w/ Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery? a. BG b. assessment of urine for blood c. weight d. oral temp A The Nurs caring for a pt at risk for an addisonian crisis. For what as/s should the nurse monitor the pt? Select all that apply: a. epistaxis b. pallor c. rapid RR d. bounding pulse e. hypotension B, C, E A pt has been assessed for aldosteronism and has recently begun tx. What are priority areas for assessment that the nurse should frequently address? Select all that apply: a. pupillary response b. creatinine and BUN levels c. potassium level d. peripheral pulses e. BP C, E The nurse is providing care for an older adult pt whose current med regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication? a. a fluoroquinolone abx b. a loop diuretic c. a proton pump inhibitor (PPI) d. a benzodiazepine D S/s of Adrenal Hyperplasia Virilization, masculine features in women (baldness, masculine distribution of pubic hair, beard, masculine beard) Meds for Adrenal Hyperplasia Glucocorticoids Topics for care plan for Cushing's Skin care, infection prevention, body image Nutrition for Cushing's Increase calcium, low sodium, low sugar Priority assessment for Cushing's Infection s/s, restlessness S/s of complications of post-op transsphenoidal hypophysectomy Clear drainage (CSF) and taste of salt Who is at highest risk for Cushing's 20-40 y/o females Priority assessments for Addison's disease HR, dysrhythmias from increased potassium Meds for Addison's Steroids (hydrocortisone- Solu-Cortef Clinical manifestations for Addison's Muscle weakness, dark pigmentation, hypotension, confusion, restlessness, N/V, cyanosis, shock Call doc if any of these symptoms occur Education for Addison's Nutrition- increase carbs, increase protein, increase salt Avoid stress and heat Diabetes insipidus med DDAVP Home care education for DI & SIADH DI- home emergency kit w/ steroids Daily weights Patho and s/s for SIADH Fluid retention, dilutional hyponatremia, watch for fluid overload (crackles) S/s of DI Polydipsia, polyphagia, hypernatremia, dehydration - tachycardia Meds for SIADH Lasix NEVER HCTZ S/s of complications of SIADH Lethargy Assessment for pheochromocytoma Urine sample for catecholemines Imaging S/s- 5 H's DONT PALPATE OR PERCUSS TUMOR Diagnostics for Pheochromocytoma Clonidine suppression test 24 hr urine for catecholamines and metanephrine abd US s/s of pheochromocytoma 5 H's HTN Headache Hyperhydrosis Hypermetabolism Hyperglycemia Palpitations Anxiety Impending Doom Priority assessments post-op thyroidectomy Fullness/tightness at site Have a trach at bedside Education for Levothyroxine Life long treatment, annual thyroid level check, take in the morning before breakfast Best position post-op thyroidectomy? Semi fowlers with pillows Potential cause of HHS Stress, illness, older adults (dehydration) S/s of HHS Blood glucose 600 Hypokalemia Ketones absent in urine Orthostatic hypotension Dehydration QSEN- NTK for hanging an insulin drip Flush IV line and discard 50mL of fluid Normal levels for serum osmolality Isotonic- 280-295 Hypotonic 280 (SIADH) Hypertonic 295 ( high BS, dehydration) Potential cause of DKA Illness, stress, poor BS control S/s of DKA Polydispia, polyuria, polyphagia, fruity breath, Metabolic acidosis-kussmaul breathing, upset GI Treatment for DKA hydration, IV insulin drip, NS 1/2 BSis400,D5W if BSis below250 Peaks and Duration for Insulins Short Acting- Regular- Peak 2-3 hr, Dur. 4-6 hr Intermediate (NPH)- P- 4-12 hr, D- 16-20 hr Long Acting- Lantus- P- none, D- 24 hr Sick day rules Take insulin Check BS Q4H Increase fluids Microvascular complications retinopathy, nephropathy, neuropathy Capillary basement membrane thickens blocking bloodflow Assessment findings with neuropathy Parathesias, numbness, decreased proprioception, burning sensation, decreased deep tendon reflexes Meds for neuropathy Gabapentin Tegretol Cymbalta Lyrica Education about foot care Control diabetes, inspect feet daily, wash feet daily, lotion but not between toes, wear shoes Drug prescribed for Diabetic GI upset Reglan - increases gastric emptying Cardiac issues with long term diabetes HTN, CAD, MI, orthostatic hypotension Early indication of nephropathy Microalbuminemia Drugs to avoid with nephropathy Gentamycin How does retinopathy develop? Microanyeurisms - swelling - macular edema - blurred vision S/s of retinopathy Floaters, cobwebs, blurry vision Metabolic acidosis values pH 7.35 HCO3 22 Complications of macrovascular issues MI, stroke, PE How does macrovascular disease develop? Blood vessel walls thicken, sclerose, occlusion by plaques - blocks blood flow Risk factors for Cushing's patients Risk for decreased skin integrity Risk for infection Risk for injury True or false: Long term steroid use can be a cause of Cushing's True True or false: Steroids must be weaned and not stopped abruptly True Dietary recommendations for patients with Cushing's Low sodium high calcium low sugar Adrenalectomy will increase the risk of which disorder? Addison's Disease Cause of DI Brain tumor Pituitary surgery Head trauma Which items are triggers of Addisonian Crisis? Stress Heat What should be included in teaching about corticosteroid treatment? Low salt diet Take in the AM w/ food Avoid large crowds DI treatment, DDAVP will produce which manifestations? Increased specific gravity Decreased urinary output What nursing intervention will help evaluate fluid status? Weight pt every AM Record I's and O's Assess skin turgor Assessment priority in SIADH ABCs Normal Urine Specific Gravity 1.005-1.030 What diuretic is recommended in SIADH? Furosemide Where are tumors in pheochromocytoma located? Adrenal glands What is the purpose of alpha-adrenergic blockers in pheochromocytoma? Lower BP What is the priority complication to monitor for post thyroidectomy? Airway obstruction due to bleeding True or false: Levothyroxine should be taken at bedtime? False What is the drug of choice for DKA and HHS? IV insulin drip Normal level of blood osmolality 280-295 Normal range for serum potassium 3.5-5 What is the priority nursing intervention with high or low potassium? Apply a cardiac monitor Norma range of serum sodium 135-145 What manifestations would you expect with high or low sodium? Neuro symptoms True or false: In severe dehydration you would expect the serum osmolality to be low False True or false: DKA may present with GI symptoms True What acid-base imbalance is common with DKA? Metabolic acidosis True or false: When preparing an insulin drip the nurse should prime the tubing with 100mL of insulin False it's 50 mL What is the priority assessment for DKA? Fluid volume status True or false: Regular insulin is the drug of choice for DKA and HHS True What is the cause of neurological dysfunction in diabetic neuropathy? Capillary membrane thickening Destruction of myelin sheath True or false: Metoclopramide is given to treat N/V in diabetic patients True Which test result is indicative of diabetic neuropathy? Microalbuminemia True or false: Patients with diabetic nephropathy should be instructed to increase dietary protein intake False What is the priority nursing diagnosis in diabetic neuropathy patients? Risk for injury True or false: it is recommended that diabetic patients get yearly eye exams True