NURS 120 Medical-Surgical Nursing Week 13 Comprehensive Exam
2026 |WCU
1. A patient is admitted with Diabetic Ketoacidosis (DKA). Which clinical finding
most clearly distinguishes DKA from Hyperosmolar Hyperglycemic State (HHS)?
A. Blood glucose level above 600 mg/dL
B. Presence of profound dehydration
C. Arterial pH level below 7.35 and presence of ketones
D. Altered mental status and lethargy
Answer: C
Rationale: DKA is characterized by metabolic acidosis and ketosis, whereas HHS typically
presents with extremely high glucose levels without significant ketosis or acidosis.
2. Which electrolyte imbalance is the primary concern during the initial
treatment phase of a patient with DKA receiving insulin therapy?
A. Hypernatremia
B. Hypercalcemia
C. Hypokalemia
D. Hypomagnesemia
Answer: C
Rationale: Insulin causes potassium to shift from the extracellular fluid into the cells,
which can lead to life-threatening hypokalemia even if initial serum levels appear normal.
,3. A patient with Grave’s Disease is experiencing a Thyroid Storm. Which
medication should the nurse expect to administer first to block the peripheral
conversion of T4 to T3?
A. Levothyroxine
B. Methimazole
C. Propylthiouracil (PTU)
D. Iodine solution
Answer: C
Rationale: PTU is preferred in thyroid storm because it inhibits the synthesis of thyroid
hormones and blocks the peripheral conversion of T4 to the more active T3.
4. Following a total thyroidectomy, the nurse notes the patient has positive
Chvostek’s and Trousseau’s signs. Which electrolyte should be replaced
immediately?
A. Potassium
B. Sodium
C. Calcium
D. Phosphorus
Answer: C
Rationale: Damage to the parathyroid glands during thyroidectomy can lead to
hypocalcemia, evidenced by neuromuscular irritability (Chvostek’s and Trousseau’s signs).
5. A patient presents with ‘moon face’, central obesity, and thin extremities.
Which diagnostic test result would support a diagnosis of Cushing’s Syndrome?
A. Decreased serum cortisol levels
B. Hyperkalemia
C. Hypoglycemia
D. Elevated 24-hour urinary free cortisol
Answer: D
, Rationale: Cushing’s Syndrome involves hypercortisolism; an elevated 24-hour urinary
free cortisol is a gold-standard diagnostic tool.
6. An Addisonian Crisis is triggered by which of the following events in a patient
with chronic adrenal insufficiency?
A. Overhydration
B. Excessive intake of dietary sodium
C. Sudden cessation of glucocorticoid therapy
D. Strenuous exercise without rest
Answer: C
Rationale: Sudden withdrawal of exogenous steroids prevents the body from mounting a
stress response, leading to acute adrenal insufficiency or crisis.
7. What is the priority nursing intervention for a patient diagnosed with
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
A. Encouraging increased fluid intake
B. Administering IV hypotonic saline
C. Restricting fluid intake to 800-1000 mL/day
D. Monitoring for signs of dehydration
Answer: C
Rationale: SIADH involves excessive water retention and dilutional hyponatremia; fluid
restriction is the primary treatment to increase serum sodium levels.
8. A patient with Diabetes Insipidus (DI) is receiving Desmopressin (DDAVP).
Which finding indicates the medication is effective?
A. Increased urine output
B. Decreased urine specific gravity
C. Decreased thirst and decreased urine output
D. Increased serum sodium levels
Answer: C
2026 |WCU
1. A patient is admitted with Diabetic Ketoacidosis (DKA). Which clinical finding
most clearly distinguishes DKA from Hyperosmolar Hyperglycemic State (HHS)?
A. Blood glucose level above 600 mg/dL
B. Presence of profound dehydration
C. Arterial pH level below 7.35 and presence of ketones
D. Altered mental status and lethargy
Answer: C
Rationale: DKA is characterized by metabolic acidosis and ketosis, whereas HHS typically
presents with extremely high glucose levels without significant ketosis or acidosis.
2. Which electrolyte imbalance is the primary concern during the initial
treatment phase of a patient with DKA receiving insulin therapy?
A. Hypernatremia
B. Hypercalcemia
C. Hypokalemia
D. Hypomagnesemia
Answer: C
Rationale: Insulin causes potassium to shift from the extracellular fluid into the cells,
which can lead to life-threatening hypokalemia even if initial serum levels appear normal.
,3. A patient with Grave’s Disease is experiencing a Thyroid Storm. Which
medication should the nurse expect to administer first to block the peripheral
conversion of T4 to T3?
A. Levothyroxine
B. Methimazole
C. Propylthiouracil (PTU)
D. Iodine solution
Answer: C
Rationale: PTU is preferred in thyroid storm because it inhibits the synthesis of thyroid
hormones and blocks the peripheral conversion of T4 to the more active T3.
4. Following a total thyroidectomy, the nurse notes the patient has positive
Chvostek’s and Trousseau’s signs. Which electrolyte should be replaced
immediately?
A. Potassium
B. Sodium
C. Calcium
D. Phosphorus
Answer: C
Rationale: Damage to the parathyroid glands during thyroidectomy can lead to
hypocalcemia, evidenced by neuromuscular irritability (Chvostek’s and Trousseau’s signs).
5. A patient presents with ‘moon face’, central obesity, and thin extremities.
Which diagnostic test result would support a diagnosis of Cushing’s Syndrome?
A. Decreased serum cortisol levels
B. Hyperkalemia
C. Hypoglycemia
D. Elevated 24-hour urinary free cortisol
Answer: D
, Rationale: Cushing’s Syndrome involves hypercortisolism; an elevated 24-hour urinary
free cortisol is a gold-standard diagnostic tool.
6. An Addisonian Crisis is triggered by which of the following events in a patient
with chronic adrenal insufficiency?
A. Overhydration
B. Excessive intake of dietary sodium
C. Sudden cessation of glucocorticoid therapy
D. Strenuous exercise without rest
Answer: C
Rationale: Sudden withdrawal of exogenous steroids prevents the body from mounting a
stress response, leading to acute adrenal insufficiency or crisis.
7. What is the priority nursing intervention for a patient diagnosed with
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
A. Encouraging increased fluid intake
B. Administering IV hypotonic saline
C. Restricting fluid intake to 800-1000 mL/day
D. Monitoring for signs of dehydration
Answer: C
Rationale: SIADH involves excessive water retention and dilutional hyponatremia; fluid
restriction is the primary treatment to increase serum sodium levels.
8. A patient with Diabetes Insipidus (DI) is receiving Desmopressin (DDAVP).
Which finding indicates the medication is effective?
A. Increased urine output
B. Decreased urine specific gravity
C. Decreased thirst and decreased urine output
D. Increased serum sodium levels
Answer: C
