NURS 120 | Introduction to Medical-Surgical Nursing | Study Guide
Exam 4 | 2026/2027 Update WCU
1. A patient is admitted with Diabetic Ketoacidosis (DKA). Which clinical finding
most specifically distinguishes DKA from Hyperosmolar Hyperglycemic State
(HHS)?
A. Presence of Kussmaul respirations and ketonuria
B. Profound dehydration and high serum osmolality
C. Blood glucose level above 600 mg/dL
D. Altered mental status and lethargy
Answer: A
Rationale: DKA is characterized by metabolic acidosis, which leads to Kussmaul
respirations and the presence of ketones in the urine. HHS typically presents with higher
glucose levels but without significant ketosis or acidosis.
2. Which electrolyte imbalance is the primary concern for a patient diagnosed
with Hypoparathyroidism post-thyroidectomy?
A. Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hypermagnesemia
Answer: C
Rationale: Accidental removal or damage to the parathyroid glands during a
thyroidectomy leads to a deficiency in PTH, causing calcium levels to drop (hypocalcemia),
often manifested by Trousseau’s or Chvostek’s signs.
,3. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of
6.8 mEq/L. What is the priority nursing intervention?
A. Administering a scheduled dose of lisinopril
B. Monitoring the patient for Chvostek’s sign
C. Encouraging a diet high in bananas and spinach
D. Placing the patient on a cardiac monitor
Answer: D
Rationale: Severe hyperkalemia (above 6.5 mEq/L) can cause life-threatening cardiac
arrhythmias. Continuous ECG monitoring is the priority for safety.
4. Which Arterial Blood Gas (ABG) result is consistent with a patient
experiencing a severe Panic Attack?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.25, PaCO2 38, HCO3 18
C. pH 7.48, PaCO2 30, HCO3 23
D. pH 7.50, PaCO2 42, HCO3 32
Answer: C
Rationale: Hyperventilation during a panic attack causes the patient to blow off too much
CO2, leading to Respiratory Alkalosis (high pH, low PaCO2).
5. A nurse is teaching a patient with Addison’s disease about their medication.
Which statement by the patient indicates a need for further teaching?
A. I will wear a medical alert bracelet at all times.
B. I need to increase my dose during times of high stress or illness.
C. I should stop taking my prednisone if I start to feel better.
D. I will carry an emergency kit with injectable hydrocortisone.
Answer: C
Rationale: Corticosteroids must never be stopped abruptly, as this can trigger an
Addisonian crisis due to adrenal insufficiency.
, 6. What is the hallmark clinical manifestation of Nephrotic Syndrome?
A. Gross hematuria and hypertension
B. Severe proteinuria and peripheral edema
C. Flank pain and high fever
D. Reduced glomerular filtration rate with oliguria
Answer: B
Rationale: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, and resulting severe generalized edema (anasarca).
7. A patient with Diabetes Mellitus is found unconscious and diaphoretic. What
is the nurse’s first action?
A. Check the patient’s blood glucose level
B. Administer 15g of simple carbohydrates orally
C. Administer IM Glucagon or IV Dextrose 50%
D. Call the provider for an insulin order
Answer: C
Rationale: In an unconscious patient suspected of hypoglycemia, oral intake is unsafe.
Emergency administration of Glucagon or IV D50 is required to raise glucose levels rapidly.
8. Which medication should be held for 48 hours before and after a patient
receives IV contrast for a CT scan?
A. Atorvastatin
B. Warfarin
C. Furosemide
D. Metformin
Answer: D
Rationale: Metformin carries a risk of lactic acidosis if the patient develops contrast-
induced nephropathy. It must be held to protect renal function.
Exam 4 | 2026/2027 Update WCU
1. A patient is admitted with Diabetic Ketoacidosis (DKA). Which clinical finding
most specifically distinguishes DKA from Hyperosmolar Hyperglycemic State
(HHS)?
A. Presence of Kussmaul respirations and ketonuria
B. Profound dehydration and high serum osmolality
C. Blood glucose level above 600 mg/dL
D. Altered mental status and lethargy
Answer: A
Rationale: DKA is characterized by metabolic acidosis, which leads to Kussmaul
respirations and the presence of ketones in the urine. HHS typically presents with higher
glucose levels but without significant ketosis or acidosis.
2. Which electrolyte imbalance is the primary concern for a patient diagnosed
with Hypoparathyroidism post-thyroidectomy?
A. Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hypermagnesemia
Answer: C
Rationale: Accidental removal or damage to the parathyroid glands during a
thyroidectomy leads to a deficiency in PTH, causing calcium levels to drop (hypocalcemia),
often manifested by Trousseau’s or Chvostek’s signs.
,3. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of
6.8 mEq/L. What is the priority nursing intervention?
A. Administering a scheduled dose of lisinopril
B. Monitoring the patient for Chvostek’s sign
C. Encouraging a diet high in bananas and spinach
D. Placing the patient on a cardiac monitor
Answer: D
Rationale: Severe hyperkalemia (above 6.5 mEq/L) can cause life-threatening cardiac
arrhythmias. Continuous ECG monitoring is the priority for safety.
4. Which Arterial Blood Gas (ABG) result is consistent with a patient
experiencing a severe Panic Attack?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.25, PaCO2 38, HCO3 18
C. pH 7.48, PaCO2 30, HCO3 23
D. pH 7.50, PaCO2 42, HCO3 32
Answer: C
Rationale: Hyperventilation during a panic attack causes the patient to blow off too much
CO2, leading to Respiratory Alkalosis (high pH, low PaCO2).
5. A nurse is teaching a patient with Addison’s disease about their medication.
Which statement by the patient indicates a need for further teaching?
A. I will wear a medical alert bracelet at all times.
B. I need to increase my dose during times of high stress or illness.
C. I should stop taking my prednisone if I start to feel better.
D. I will carry an emergency kit with injectable hydrocortisone.
Answer: C
Rationale: Corticosteroids must never be stopped abruptly, as this can trigger an
Addisonian crisis due to adrenal insufficiency.
, 6. What is the hallmark clinical manifestation of Nephrotic Syndrome?
A. Gross hematuria and hypertension
B. Severe proteinuria and peripheral edema
C. Flank pain and high fever
D. Reduced glomerular filtration rate with oliguria
Answer: B
Rationale: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, and resulting severe generalized edema (anasarca).
7. A patient with Diabetes Mellitus is found unconscious and diaphoretic. What
is the nurse’s first action?
A. Check the patient’s blood glucose level
B. Administer 15g of simple carbohydrates orally
C. Administer IM Glucagon or IV Dextrose 50%
D. Call the provider for an insulin order
Answer: C
Rationale: In an unconscious patient suspected of hypoglycemia, oral intake is unsafe.
Emergency administration of Glucagon or IV D50 is required to raise glucose levels rapidly.
8. Which medication should be held for 48 hours before and after a patient
receives IV contrast for a CT scan?
A. Atorvastatin
B. Warfarin
C. Furosemide
D. Metformin
Answer: D
Rationale: Metformin carries a risk of lactic acidosis if the patient develops contrast-
induced nephropathy. It must be held to protect renal function.
