NU189 | NU 189 Medical-Surgical Nursing II Exam
1 v2 | Questions with Correct Answers and Expert
Explanation for Each Question | Galen
1. A patient with Type 1 Diabetes Mellitus presents with a blood glucose of 620 mg/dL,
Kussmaul respirations, and a fruity breath odor. What is the nurse’s first priority
intervention?
A. Administering a bolus of intravenous regular insulin.
B. Checking the patient’s potassium level immediately.
C. Initiating rapid intravenous infusion of 0.9% Normal Saline.
D. Preparing the patient for an arterial blood gas (ABG) draw.
Correct Answer: C
Expert Explanation: The patient is presenting with signs of Diabetic Ketoacidosis
(DKA), and the immediate priority is fluid resuscitation to restore circulatory
volume. Dehydration in DKA is often severe due to osmotic diuresis, and stabilizing
the blood pressure is the first step. Once fluid replacement is initiated, insulin
therapy can be started to address the hyperglycemia and ketosis.
2. Which clinical manifestation should the nurse expect to find in a patient diagnosed
with Cushing’s Syndrome?
A. Truncal obesity and a ‘buffalo hump’ on the upper back.
,B. Hypotension and high serum potassium levels.
C. Weight loss and hyperpigmentation of the skin.
D. Decreased blood glucose levels and muscle wasting.
Correct Answer: A
Expert Explanation: Cushing’s Syndrome is characterized by an excess of cortisol,
which leads to a redistribution of fat in the trunk and upper back. This often results
in a round ‘moon face’ and a ‘buffalo hump’ between the shoulders. Other symptoms
include hypertension, hyperglycemia, and thin skin with striae.
3. A patient is recovering from a subtotal thyroidectomy. The nurse notes the patient
is experiencing numbness and tingling in the fingers and around the mouth. Which
action is most appropriate?
A. Assess for Chvostek’s sign and notify the healthcare provider.
B. Reassure the patient that this is a normal side effect of anesthesia.
C. Increase the rate of the intravenous fluids to flush out medication.
D. Encourage the patient to perform deep breathing exercises.
Correct Answer: A
Expert Explanation: Numbness and tingling (paresthesia) are early signs of
hypocalcemia, which can occur after thyroid surgery if the parathyroid glands are
,accidentally damaged or removed. The nurse should assess for Chvostek’s sign by
tapping the facial nerve to see if the facial muscles twitch. Immediate notification of
the provider is necessary to prevent tetany and respiratory distress.
4. Which arterial blood gas (ABG) result indicates that a patient is in a state of
uncompensated Respiratory Acidosis?
A. pH 7.50, PaCO2 30 mmHg, HCO3 22 mEq/L
B. pH 7.30, PaCO2 50 mmHg, HCO3 24 mEq/L
C. pH 7.32, PaCO2 40 mmHg, HCO3 18 mEq/L
D. pH 7.42, PaCO2 38 mmHg, HCO3 24 mEq/L
Correct Answer: B
Expert Explanation: A pH of 7.30 indicates acidosis, and a PaCO2 of 50 mmHg
indicates a respiratory cause for that acidosis. Since the HCO3 (bicarbonate) is
within the normal range of 22-26 mEq/L, it indicates that the kidneys have not yet
started to compensate. This pattern is consistent with acute respiratory failure or
sedation.
5. A patient with Diabetes Insipidus (DI) is receiving Desmopressin (DDAVP). Which
finding indicates that the medication is effective?
A. Serum sodium level increases to 150 mEq/L.
B. Urine output increases to 500 mL per hour.
, C. The patient’s thirst increases significantly.
D. Urine specific gravity increases from 1.002 to 1.015.
Correct Answer: D
Expert Explanation: Desmopressin acts as an antidiuretic hormone (ADH)
replacement, which helps the kidneys reabsorb water. An increase in urine specific
gravity indicates that the urine is becoming more concentrated, which is the desired
effect. Successful treatment also results in decreased thirst and decreased urine
output volume.
6. Which electrolyte imbalance is a patient at risk for if they are taking Spironolactone
(Aldactone) for heart failure?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Correct Answer: C
Expert Explanation: Spironolactone is a potassium-sparing diuretic that works by
antagonizing aldosterone in the kidneys. This leads to the excretion of sodium and
1 v2 | Questions with Correct Answers and Expert
Explanation for Each Question | Galen
1. A patient with Type 1 Diabetes Mellitus presents with a blood glucose of 620 mg/dL,
Kussmaul respirations, and a fruity breath odor. What is the nurse’s first priority
intervention?
A. Administering a bolus of intravenous regular insulin.
B. Checking the patient’s potassium level immediately.
C. Initiating rapid intravenous infusion of 0.9% Normal Saline.
D. Preparing the patient for an arterial blood gas (ABG) draw.
Correct Answer: C
Expert Explanation: The patient is presenting with signs of Diabetic Ketoacidosis
(DKA), and the immediate priority is fluid resuscitation to restore circulatory
volume. Dehydration in DKA is often severe due to osmotic diuresis, and stabilizing
the blood pressure is the first step. Once fluid replacement is initiated, insulin
therapy can be started to address the hyperglycemia and ketosis.
2. Which clinical manifestation should the nurse expect to find in a patient diagnosed
with Cushing’s Syndrome?
A. Truncal obesity and a ‘buffalo hump’ on the upper back.
,B. Hypotension and high serum potassium levels.
C. Weight loss and hyperpigmentation of the skin.
D. Decreased blood glucose levels and muscle wasting.
Correct Answer: A
Expert Explanation: Cushing’s Syndrome is characterized by an excess of cortisol,
which leads to a redistribution of fat in the trunk and upper back. This often results
in a round ‘moon face’ and a ‘buffalo hump’ between the shoulders. Other symptoms
include hypertension, hyperglycemia, and thin skin with striae.
3. A patient is recovering from a subtotal thyroidectomy. The nurse notes the patient
is experiencing numbness and tingling in the fingers and around the mouth. Which
action is most appropriate?
A. Assess for Chvostek’s sign and notify the healthcare provider.
B. Reassure the patient that this is a normal side effect of anesthesia.
C. Increase the rate of the intravenous fluids to flush out medication.
D. Encourage the patient to perform deep breathing exercises.
Correct Answer: A
Expert Explanation: Numbness and tingling (paresthesia) are early signs of
hypocalcemia, which can occur after thyroid surgery if the parathyroid glands are
,accidentally damaged or removed. The nurse should assess for Chvostek’s sign by
tapping the facial nerve to see if the facial muscles twitch. Immediate notification of
the provider is necessary to prevent tetany and respiratory distress.
4. Which arterial blood gas (ABG) result indicates that a patient is in a state of
uncompensated Respiratory Acidosis?
A. pH 7.50, PaCO2 30 mmHg, HCO3 22 mEq/L
B. pH 7.30, PaCO2 50 mmHg, HCO3 24 mEq/L
C. pH 7.32, PaCO2 40 mmHg, HCO3 18 mEq/L
D. pH 7.42, PaCO2 38 mmHg, HCO3 24 mEq/L
Correct Answer: B
Expert Explanation: A pH of 7.30 indicates acidosis, and a PaCO2 of 50 mmHg
indicates a respiratory cause for that acidosis. Since the HCO3 (bicarbonate) is
within the normal range of 22-26 mEq/L, it indicates that the kidneys have not yet
started to compensate. This pattern is consistent with acute respiratory failure or
sedation.
5. A patient with Diabetes Insipidus (DI) is receiving Desmopressin (DDAVP). Which
finding indicates that the medication is effective?
A. Serum sodium level increases to 150 mEq/L.
B. Urine output increases to 500 mL per hour.
, C. The patient’s thirst increases significantly.
D. Urine specific gravity increases from 1.002 to 1.015.
Correct Answer: D
Expert Explanation: Desmopressin acts as an antidiuretic hormone (ADH)
replacement, which helps the kidneys reabsorb water. An increase in urine specific
gravity indicates that the urine is becoming more concentrated, which is the desired
effect. Successful treatment also results in decreased thirst and decreased urine
output volume.
6. Which electrolyte imbalance is a patient at risk for if they are taking Spironolactone
(Aldactone) for heart failure?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Correct Answer: C
Expert Explanation: Spironolactone is a potassium-sparing diuretic that works by
antagonizing aldosterone in the kidneys. This leads to the excretion of sodium and
