NUR612/NUR 612 Exam 4 V1 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A patient presents with extreme polyuria and a urine specific gravity of 1.002. Which
diagnostic test is most effective at differentiating central from nephrogenic diabetes
insipidus?
A. Random plasma glucose level
B. Water deprivation test with vasopressin administration
C. 24-hour urine collection for creatinine clearance
D. Serum aldosterone and renin levels
Correct Answer: B
Expert Explanation: The water deprivation test followed by vasopressin administration
allows the clinician to see if the kidneys can concentrate urine when exogenous ADH is
provided. In central diabetes insipidus, the urine osmolality will increase significantly after
the vasopressin injection. In nephrogenic diabetes insipidus, the kidneys fail to respond to
the hormone, indicating a peripheral receptor issue.
2. Which laboratory marker is the most sensitive early indicator of iron deficiency anemia
before the red blood cells become microcytic?
A. Hemoglobin level
,B. Mean corpuscular volume (MCV)
C. Serum ferritin level
D. Reticulocyte count
Correct Answer: C
Expert Explanation: Serum ferritin reflects the total body iron stores and is the first value
to drop as iron is depleted. Hemoglobin and MCV often remain within normal limits during
the early stages of iron deficiency. Identifying low ferritin allows for early intervention
before the patient develops symptomatic anemia.
3. In a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH), what is the
primary physiological mechanism for the resulting hyponatremia?
A. Excessive sodium excretion in the urine
B. Shift of sodium from the extracellular to intracellular space
C. Inadequate intake of dietary sodium
D. Dilutional hyponatremia due to water retention
Correct Answer: D
Expert Explanation: SIADH is characterized by the excessive release of ADH, which causes
the kidneys to reabsorb water regardless of the body’s hydration status. This results in an
expanded extracellular fluid volume that dilutes the existing sodium concentration. The
hyponatremia is therefore a result of water excess rather than a true sodium deficit.
, 4. A patient with Cushing’s syndrome is likely to exhibit which of the following metabolic
abnormalities?
A. Hypoglycemia and hyperkalemia
B. Hyperglycemia and hypokalemia
C. Hyponatremia and metabolic acidosis
D. Hypocalcemia and hypermagnesemia
Correct Answer: B
Expert Explanation: Excess cortisol in Cushing’s syndrome promotes gluconeogenesis,
which frequently leads to secondary hyperglycemia or glucose intolerance. Additionally,
high levels of cortisol can have mineralocorticoid effects, leading to the excretion of
potassium and retention of sodium. This combination often results in hypokalemia and
elevated blood pressure.
5. What is the hallmark clinical finding in a patient experiencing an Addisonian crisis?
A. Severe hypertension and tachycardia
B. Hyperglycemia and metabolic alkalosis
C. Profound hypotension unresponsive to fluids
D. Peripheral edema and weight gain
Correct Answer: C
Nursing II Q&A with Rationale | William
Paterson University
1. A patient presents with extreme polyuria and a urine specific gravity of 1.002. Which
diagnostic test is most effective at differentiating central from nephrogenic diabetes
insipidus?
A. Random plasma glucose level
B. Water deprivation test with vasopressin administration
C. 24-hour urine collection for creatinine clearance
D. Serum aldosterone and renin levels
Correct Answer: B
Expert Explanation: The water deprivation test followed by vasopressin administration
allows the clinician to see if the kidneys can concentrate urine when exogenous ADH is
provided. In central diabetes insipidus, the urine osmolality will increase significantly after
the vasopressin injection. In nephrogenic diabetes insipidus, the kidneys fail to respond to
the hormone, indicating a peripheral receptor issue.
2. Which laboratory marker is the most sensitive early indicator of iron deficiency anemia
before the red blood cells become microcytic?
A. Hemoglobin level
,B. Mean corpuscular volume (MCV)
C. Serum ferritin level
D. Reticulocyte count
Correct Answer: C
Expert Explanation: Serum ferritin reflects the total body iron stores and is the first value
to drop as iron is depleted. Hemoglobin and MCV often remain within normal limits during
the early stages of iron deficiency. Identifying low ferritin allows for early intervention
before the patient develops symptomatic anemia.
3. In a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH), what is the
primary physiological mechanism for the resulting hyponatremia?
A. Excessive sodium excretion in the urine
B. Shift of sodium from the extracellular to intracellular space
C. Inadequate intake of dietary sodium
D. Dilutional hyponatremia due to water retention
Correct Answer: D
Expert Explanation: SIADH is characterized by the excessive release of ADH, which causes
the kidneys to reabsorb water regardless of the body’s hydration status. This results in an
expanded extracellular fluid volume that dilutes the existing sodium concentration. The
hyponatremia is therefore a result of water excess rather than a true sodium deficit.
, 4. A patient with Cushing’s syndrome is likely to exhibit which of the following metabolic
abnormalities?
A. Hypoglycemia and hyperkalemia
B. Hyperglycemia and hypokalemia
C. Hyponatremia and metabolic acidosis
D. Hypocalcemia and hypermagnesemia
Correct Answer: B
Expert Explanation: Excess cortisol in Cushing’s syndrome promotes gluconeogenesis,
which frequently leads to secondary hyperglycemia or glucose intolerance. Additionally,
high levels of cortisol can have mineralocorticoid effects, leading to the excretion of
potassium and retention of sodium. This combination often results in hypokalemia and
elevated blood pressure.
5. What is the hallmark clinical finding in a patient experiencing an Addisonian crisis?
A. Severe hypertension and tachycardia
B. Hyperglycemia and metabolic alkalosis
C. Profound hypotension unresponsive to fluids
D. Peripheral edema and weight gain
Correct Answer: C
