PNR 206/PNR206 Exam 3 V3 | Medical-
Surgical Nursing II Q&A with Rationale |
Fortis College
1. A patient with a diagnosis of Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is
admitted to the unit. Which clinical manifestation should the nurse anticipate during the
assessment?
A. Excessive thirst and polyuria
B. Increased serum osmolarity
C. Weight loss and hypotension
D. Hyponatremia and fluid retention
Correct Answer: D
Expert Explanation: SIADH results from the overproduction of antidiuretic hormone,
leading to water reabsorption in the kidneys. This causes dilutional hyponatremia and fluid
volume excess without peripheral edema. The nurse must monitor for neurological
changes as sodium levels drop below 120 mEq/L.
2. A nurse is caring for a patient who underwent a total thyroidectomy 12 hours ago. The
patient reports numbness and tingling around the mouth and in the fingertips. What is the
priority nursing action?
A. Administer a prescribed analgesic for postoperative pain
,B. Check the surgical dressing for signs of hemorrhage
C. Encourage the patient to use an incentive spirometer
D. Assess for Chvostek’s sign and notify the provider
Correct Answer: D
Expert Explanation: Numbness and tingling are early signs of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during thyroid
surgery. Chvostek’s sign is a clinical indicator of hypocalcemia triggered by tapping the
facial nerve. Failure to address low calcium levels can lead to tetany and respiratory
distress.
3. A patient is diagnosed with Diabetes Insipidus (DI) following a head injury. Which
laboratory finding is most consistent with this diagnosis?
A. Urine specific gravity of 1.002
B. Serum sodium of 130 mEq/L
C. Blood glucose of 250 mg/dL
D. Urine osmolarity of 1200 mOsm/kg
Correct Answer: A
Expert Explanation: Diabetes Insipidus is characterized by a deficiency of ADH, leading to
the excretion of large volumes of dilute urine. A low urine specific gravity (typically less
,than 1.005) confirms the inability of the kidneys to concentrate urine. The patient is at high
risk for dehydration and hypernatremia due to massive fluid loss.
4. The nurse is providing discharge instructions to a patient with Addison’s disease. Which
statement by the patient indicates a need for further teaching?
A. ‘I should wear a medical alert bracelet at all times.’
B. ‘I can skip a dose of my medication if I feel nauseated.’
C. ‘I will need to take my steroid medications for the rest of my life.’
D. ‘I should increase my salt intake during hot weather.’
Correct Answer: B
Expert Explanation: Patients with Addison’s disease require lifelong glucocorticoid and
mineralocorticoid replacement therapy. Skipping doses can precipitate an Addisonian
crisis, which is a life-threatening emergency. During times of stress or illness, the
medication dosage often needs to be increased, not decreased.
5. A patient with Cushing’s Syndrome is being monitored for complications. Which
assessment finding should the nurse report to the healthcare provider immediately?
A. New onset of a productive cough and fever
B. A blood pressure reading of 158/94 mmHg
C. Purple striae on the abdomen
D. Weight gain of 2 pounds in one week
, Correct Answer: A
Expert Explanation: Hypercortisolism in Cushing’s Syndrome suppresses the immune
system and masks early signs of infection. A fever and productive cough may indicate a
serious infection that the patient’s body cannot effectively fight. While hypertension and
weight gain are common in Cushing’s, an active infection is a higher priority for immediate
intervention.
6. Which of the following interventions is the priority for a nurse managing a patient in
Diabetic Ketoacidosis (DKA)?
A. Starting an IV infusion of 0.9% Normal Saline
B. Administering subcutaneous long-acting insulin
C. Providing a carbohydrate-rich snack
D. Teaching the patient about carbohydrate counting
Correct Answer: A
Expert Explanation: The initial priority in DKA is fluid resuscitation to restore circulatory
volume and stabilize blood pressure. Dehydration in DKA is severe due to osmotic diuresis
caused by hyperglycemia. Once fluid replacement is initiated, IV regular insulin is
administered to lower blood glucose and stop ketone production.
7. A patient with Type 2 Diabetes is prescribed Metformin. Which information should the
nurse include when teaching the patient about this medication?
A. ‘Metformin stimulates the pancreas to produce more insulin.’
Surgical Nursing II Q&A with Rationale |
Fortis College
1. A patient with a diagnosis of Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is
admitted to the unit. Which clinical manifestation should the nurse anticipate during the
assessment?
A. Excessive thirst and polyuria
B. Increased serum osmolarity
C. Weight loss and hypotension
D. Hyponatremia and fluid retention
Correct Answer: D
Expert Explanation: SIADH results from the overproduction of antidiuretic hormone,
leading to water reabsorption in the kidneys. This causes dilutional hyponatremia and fluid
volume excess without peripheral edema. The nurse must monitor for neurological
changes as sodium levels drop below 120 mEq/L.
2. A nurse is caring for a patient who underwent a total thyroidectomy 12 hours ago. The
patient reports numbness and tingling around the mouth and in the fingertips. What is the
priority nursing action?
A. Administer a prescribed analgesic for postoperative pain
,B. Check the surgical dressing for signs of hemorrhage
C. Encourage the patient to use an incentive spirometer
D. Assess for Chvostek’s sign and notify the provider
Correct Answer: D
Expert Explanation: Numbness and tingling are early signs of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during thyroid
surgery. Chvostek’s sign is a clinical indicator of hypocalcemia triggered by tapping the
facial nerve. Failure to address low calcium levels can lead to tetany and respiratory
distress.
3. A patient is diagnosed with Diabetes Insipidus (DI) following a head injury. Which
laboratory finding is most consistent with this diagnosis?
A. Urine specific gravity of 1.002
B. Serum sodium of 130 mEq/L
C. Blood glucose of 250 mg/dL
D. Urine osmolarity of 1200 mOsm/kg
Correct Answer: A
Expert Explanation: Diabetes Insipidus is characterized by a deficiency of ADH, leading to
the excretion of large volumes of dilute urine. A low urine specific gravity (typically less
,than 1.005) confirms the inability of the kidneys to concentrate urine. The patient is at high
risk for dehydration and hypernatremia due to massive fluid loss.
4. The nurse is providing discharge instructions to a patient with Addison’s disease. Which
statement by the patient indicates a need for further teaching?
A. ‘I should wear a medical alert bracelet at all times.’
B. ‘I can skip a dose of my medication if I feel nauseated.’
C. ‘I will need to take my steroid medications for the rest of my life.’
D. ‘I should increase my salt intake during hot weather.’
Correct Answer: B
Expert Explanation: Patients with Addison’s disease require lifelong glucocorticoid and
mineralocorticoid replacement therapy. Skipping doses can precipitate an Addisonian
crisis, which is a life-threatening emergency. During times of stress or illness, the
medication dosage often needs to be increased, not decreased.
5. A patient with Cushing’s Syndrome is being monitored for complications. Which
assessment finding should the nurse report to the healthcare provider immediately?
A. New onset of a productive cough and fever
B. A blood pressure reading of 158/94 mmHg
C. Purple striae on the abdomen
D. Weight gain of 2 pounds in one week
, Correct Answer: A
Expert Explanation: Hypercortisolism in Cushing’s Syndrome suppresses the immune
system and masks early signs of infection. A fever and productive cough may indicate a
serious infection that the patient’s body cannot effectively fight. While hypertension and
weight gain are common in Cushing’s, an active infection is a higher priority for immediate
intervention.
6. Which of the following interventions is the priority for a nurse managing a patient in
Diabetic Ketoacidosis (DKA)?
A. Starting an IV infusion of 0.9% Normal Saline
B. Administering subcutaneous long-acting insulin
C. Providing a carbohydrate-rich snack
D. Teaching the patient about carbohydrate counting
Correct Answer: A
Expert Explanation: The initial priority in DKA is fluid resuscitation to restore circulatory
volume and stabilize blood pressure. Dehydration in DKA is severe due to osmotic diuresis
caused by hyperglycemia. Once fluid replacement is initiated, IV regular insulin is
administered to lower blood glucose and stop ketone production.
7. A patient with Type 2 Diabetes is prescribed Metformin. Which information should the
nurse include when teaching the patient about this medication?
A. ‘Metformin stimulates the pancreas to produce more insulin.’
