NSG-320 Final Exam - (Latest 2026/2027 Update) Comprehensive Medical-
Surgical Nursing | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Medical-Surgical Nursing / Comprehensive Review
Source: NSG-320 Final Exam – Complete Study Guide
Format: Q&A Guide with Clinical Rationale
1: What is the Somogyi effect and what is its intervention?
Correct Answer: Rebound morning hyperglycemia following a nighttime episode of hypoglycemia.
Treatment: lower nighttime insulin dose, snack before bedtime.
1. Check 2-3 AM glucose to diagnose.
2. Caused by counterregulatory hormone release.
3. Differentiate from Dawn phenomenon (no hypoglycemia at night).
2: What is the Dawn phenomenon and what is its intervention?
Correct Answer: Morning hyperglycemia due to surge of growth hormone and cortisol. Treatment: late
evening dose of intermediate-acting insulin or adjustment in timing of insulin.
1. No nocturnal hypoglycemia.
2. Increase evening insulin dose.
3. Adjust timing of basal insulin administration.
3: What is hypoglycemia emergency care for a conscious patient?
Correct Answer: 15 grams of carbohydrates. Retest in 15 minutes, repeat if necessary. At home, clients
can administer glucagon if Rule of 15 doesn't work.
1. Examples: 4 oz juice, 3-4 glucose tablets, 1 tbsp honey.
2. Follow with complex carb and protein once stable.
3. Avoid chocolate due to fat content (slows absorption).
4: What do you give a patient with hypoglycemia if they are unconscious?
Correct Answer: IV Dextrose 50% immediately.
1. IV D50W 25-50 mL push.
2. If no IV access: glucagon 1 mg IM.
3. Position patient side-lying to prevent aspiration.
,5: What are diabetic foot care teaching points?
Correct Answer: Inspect daily, avoid going barefoot, proper footwear, treat cuts, avoid hot water,
cotton stockings, nail trimming, dry between toes.
1. Neuropathy reduces sensation - inspect for injuries.
2. Use lukewarm water (test temperature with elbow).
3. Trim nails straight across.
6: What are hyperthyroidism clinical manifestations?
Correct Answer: Increased metabolic processes, heat intolerance, tachycardia, weight loss.
1. Also: anxiety, tremors, palpitations, insomnia.
2. Increased appetite with weight loss.
3. Intolerance to heat, diaphoresis.
7: What are Graves disease symptoms?
Correct Answer: Enlarged thyroid gland, goiter, exophthalmos (protruding eyes).
1. Autoimmune hyperthyroidism.
2. Thyroid bruit on auscultation.
3. Pretibial myxedema (skin changes on shins).
8: What are Grave's disease interventions?
Correct Answer: Eye care, education, smoking cessation, artificial tears, eye gel/ointment, eye taping
or eye patch at night, HOB elevated for eye puffiness, wear sunglasses when outside.
1. Protect cornea from drying.
2. Moisten eyes frequently.
3. Smoking cessation reduces ophthalmopathy progression.
9: What are hypothyroidism clinical manifestations?
Correct Answer: Decreased metabolic processes, weakness, lethargy, cold intolerance, weight gain,
bradycardia.
1. Also: constipation, dry skin, hair loss, depression.
2. Myxedema (non-pitting edema).
3. Muscle aches, joint stiffness.
10: What are Hashimoto's thyroiditis interventions?
Correct Answer: Levothyroxine, need for lifelong therapy, take thyroid hormone in the morning
BEFORE food, comfortable warm environment.
1. Take on empty stomach 30-60 min before breakfast.
2. Separate from calcium, iron by 4 hours.
3. Monitor TSH to adjust dose.
, 11: What are hypernatremia clinical manifestations?
Correct Answer: Thirst, changes in mental status, seizures, coma, fluid volume deficit.
1. Intense thirst is early sign.
2. Neurologic symptoms from brain cell shrinkage.
3. Causes: dehydration, DI, hypertonic fluids.
12: What are hyponatremia clinical manifestations?
Correct Answer: Headache, irritability, difficulty concentrating, confusion, vomiting, seizures, coma.
1. Neurologic symptoms from cerebral edema.
2. Severe <120 causes seizures, coma.
3. Correct slowly to avoid osmotic demyelination.
13: What are hyperkalemia clinical manifestations?
Correct Answer: Life-threatening arrhythmias (peaked T waves), fatigue, confusion, tetany, muscle
cramps, weak or paralyzed skeletal muscles, abdominal cramping or diarrhea.
1. ECG: peaked T waves, wide QRS, flat P waves.
2. Muscle weakness progresses to paralysis.
3. Emergency treatment: calcium gluconate, insulin/glucose, kayexalate, dialysis.
14: What are hypokalemia clinical manifestations?
Correct Answer: Cardiac (depressed T wave, U waves), skeletal muscle weakness and paresthesia,
weakness of respiratory muscles, decreased GI motility, hyperglycemia.
1. ECG: flattened T waves, prominent U waves.
2. Risk of torsades de pointes.
3. Causes: diuretics, vomiting, diarrhea.
15: What are hypercalcemia manifestations?
Correct Answer: Hyperparathyroidism, fatigue, lethargy, weakness, confusion, hallucinations, seizures,
coma, dysrhythmias, bone pain, fractures, nephrolithiasis, polyuria, dehydration.
1. "Stones, bones, groans, psychiatric overtones."
2. Nephrolithiasis from calcium excretion.
3. Shortened QT interval on ECG.
16: What are hypercalcemia interventions?
Correct Answer: Increase fluid intake (3000-4000 mL), cranberry or prune juice.
1. Hydration promotes calcium excretion.
2. Loop diuretics to increase excretion.
3. Bisphosphonates for severe hypercalcemia.
Surgical Nursing | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Medical-Surgical Nursing / Comprehensive Review
Source: NSG-320 Final Exam – Complete Study Guide
Format: Q&A Guide with Clinical Rationale
1: What is the Somogyi effect and what is its intervention?
Correct Answer: Rebound morning hyperglycemia following a nighttime episode of hypoglycemia.
Treatment: lower nighttime insulin dose, snack before bedtime.
1. Check 2-3 AM glucose to diagnose.
2. Caused by counterregulatory hormone release.
3. Differentiate from Dawn phenomenon (no hypoglycemia at night).
2: What is the Dawn phenomenon and what is its intervention?
Correct Answer: Morning hyperglycemia due to surge of growth hormone and cortisol. Treatment: late
evening dose of intermediate-acting insulin or adjustment in timing of insulin.
1. No nocturnal hypoglycemia.
2. Increase evening insulin dose.
3. Adjust timing of basal insulin administration.
3: What is hypoglycemia emergency care for a conscious patient?
Correct Answer: 15 grams of carbohydrates. Retest in 15 minutes, repeat if necessary. At home, clients
can administer glucagon if Rule of 15 doesn't work.
1. Examples: 4 oz juice, 3-4 glucose tablets, 1 tbsp honey.
2. Follow with complex carb and protein once stable.
3. Avoid chocolate due to fat content (slows absorption).
4: What do you give a patient with hypoglycemia if they are unconscious?
Correct Answer: IV Dextrose 50% immediately.
1. IV D50W 25-50 mL push.
2. If no IV access: glucagon 1 mg IM.
3. Position patient side-lying to prevent aspiration.
,5: What are diabetic foot care teaching points?
Correct Answer: Inspect daily, avoid going barefoot, proper footwear, treat cuts, avoid hot water,
cotton stockings, nail trimming, dry between toes.
1. Neuropathy reduces sensation - inspect for injuries.
2. Use lukewarm water (test temperature with elbow).
3. Trim nails straight across.
6: What are hyperthyroidism clinical manifestations?
Correct Answer: Increased metabolic processes, heat intolerance, tachycardia, weight loss.
1. Also: anxiety, tremors, palpitations, insomnia.
2. Increased appetite with weight loss.
3. Intolerance to heat, diaphoresis.
7: What are Graves disease symptoms?
Correct Answer: Enlarged thyroid gland, goiter, exophthalmos (protruding eyes).
1. Autoimmune hyperthyroidism.
2. Thyroid bruit on auscultation.
3. Pretibial myxedema (skin changes on shins).
8: What are Grave's disease interventions?
Correct Answer: Eye care, education, smoking cessation, artificial tears, eye gel/ointment, eye taping
or eye patch at night, HOB elevated for eye puffiness, wear sunglasses when outside.
1. Protect cornea from drying.
2. Moisten eyes frequently.
3. Smoking cessation reduces ophthalmopathy progression.
9: What are hypothyroidism clinical manifestations?
Correct Answer: Decreased metabolic processes, weakness, lethargy, cold intolerance, weight gain,
bradycardia.
1. Also: constipation, dry skin, hair loss, depression.
2. Myxedema (non-pitting edema).
3. Muscle aches, joint stiffness.
10: What are Hashimoto's thyroiditis interventions?
Correct Answer: Levothyroxine, need for lifelong therapy, take thyroid hormone in the morning
BEFORE food, comfortable warm environment.
1. Take on empty stomach 30-60 min before breakfast.
2. Separate from calcium, iron by 4 hours.
3. Monitor TSH to adjust dose.
, 11: What are hypernatremia clinical manifestations?
Correct Answer: Thirst, changes in mental status, seizures, coma, fluid volume deficit.
1. Intense thirst is early sign.
2. Neurologic symptoms from brain cell shrinkage.
3. Causes: dehydration, DI, hypertonic fluids.
12: What are hyponatremia clinical manifestations?
Correct Answer: Headache, irritability, difficulty concentrating, confusion, vomiting, seizures, coma.
1. Neurologic symptoms from cerebral edema.
2. Severe <120 causes seizures, coma.
3. Correct slowly to avoid osmotic demyelination.
13: What are hyperkalemia clinical manifestations?
Correct Answer: Life-threatening arrhythmias (peaked T waves), fatigue, confusion, tetany, muscle
cramps, weak or paralyzed skeletal muscles, abdominal cramping or diarrhea.
1. ECG: peaked T waves, wide QRS, flat P waves.
2. Muscle weakness progresses to paralysis.
3. Emergency treatment: calcium gluconate, insulin/glucose, kayexalate, dialysis.
14: What are hypokalemia clinical manifestations?
Correct Answer: Cardiac (depressed T wave, U waves), skeletal muscle weakness and paresthesia,
weakness of respiratory muscles, decreased GI motility, hyperglycemia.
1. ECG: flattened T waves, prominent U waves.
2. Risk of torsades de pointes.
3. Causes: diuretics, vomiting, diarrhea.
15: What are hypercalcemia manifestations?
Correct Answer: Hyperparathyroidism, fatigue, lethargy, weakness, confusion, hallucinations, seizures,
coma, dysrhythmias, bone pain, fractures, nephrolithiasis, polyuria, dehydration.
1. "Stones, bones, groans, psychiatric overtones."
2. Nephrolithiasis from calcium excretion.
3. Shortened QT interval on ECG.
16: What are hypercalcemia interventions?
Correct Answer: Increase fluid intake (3000-4000 mL), cranberry or prune juice.
1. Hydration promotes calcium excretion.
2. Loop diuretics to increase excretion.
3. Bisphosphonates for severe hypercalcemia.
