NUR 304 | NUR304 Exam 3: Med Surg - MCPHS
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with Type 1 Diabetes presents to the ER with a blood glucose of 580 mg/dL,
arterial pH of 7.25, and serum potassium of 3.3 mEq/L. Which provider order should the
nurse prioritize first?
A. Initiate a continuous insulin infusion at 0.1 units/kg/hr.
B. Obtain an electrocardiogram (ECG) and chest X-ray.
C. Administer intravenous potassium chloride 20 mEq.
D. Administer 0.9% Normal Saline at 1000 mL/hr.
Correct Answer: D
Rationale: In Diabetic Ketoacidosis (DKA), the primary concern is severe dehydration and
hypovolemia due to osmotic diuresis. Administering 0.9% Normal Saline is the immediate
priority to restore circulatory volume and improve renal perfusion. While insulin is
necessary to stop ketone production, it should be delayed until fluid resuscitation is
underway and potassium levels are confirmed. Starting insulin before fluids or when
potassium is low can cause a fatal shift of potassium into the cells. Therefore, fluid
resuscitation remains the first-line intervention in the management of DKA.
2. A client with cirrhosis and esophageal varices is being treated with lactulose. Which
laboratory finding indicates that the medication is achieving its therapeutic effect?
A. Decreased prothrombin time (PT)
B. Increased serum albumin level
C. Decreased serum ammonia level
D. Increased serum potassium level
Correct Answer: C
Rationale: Lactulose is an osmotic laxative used primarily in liver failure to reduce the
absorption of ammonia from the gut. It works by acidifying the colon, which converts
ammonia into ammonium, trapping it for excretion in the stool. A decrease in serum
ammonia levels directly correlates with the prevention and treatment of hepatic
encephalopathy. The medication typically causes 2 to 3 soft stools per day, which is the
expected clinical response. Other values like albumin or PT reflect liver synthetic function
and are not directly affected by lactulose.
,3. Following a thyroidectomy, a patient reports numbness and tingling around the mouth and
in the fingertips. What is the nurse’s priority action?
A. Check the patient’s temperature for signs of thyroid storm.
B. Administer oral Levothyroxine as prescribed.
C. Increase the IV rate of D5W and Normal Saline.
D. Assess for Chvostek’s sign and notify the surgeon.
Correct Answer: D
Rationale: Numbness and tingling around the mouth (circumoral paresthesia) are classic
early signs of hypocalcemia, which can occur if the parathyroid glands are accidentally
damaged or removed during a thyroidectomy. The nurse should immediately assess for
Chvostek’s sign or Trousseau’s sign to confirm neuromuscular irritability. Notifying the
surgeon is essential because severe hypocalcemia can lead to laryngospasm and seizures.
Emergency calcium gluconate should be readily available at the bedside for intravenous
administration. While thyroid storm is a concern, the specific symptoms of paresthesia
point directly to calcium imbalance.
4. A patient with Acute Kidney Injury (AKI) enters the oliguric phase. Which clinical
manifestation should the nurse anticipate during this stage?
A. Serum potassium of 3.2 mEq/L
B. BUN and Creatinine elevation
C. Fluid volume deficit and hypotension
D. Increased urine specific gravity
Correct Answer: B
Rationale: The oliguric phase of AKI is characterized by a significant decrease in urine
output, typically less than 400 mL/day. During this phase, the kidneys fail to excrete
metabolic waste, leading to a rise in Blood Urea Nitrogen (BUN) and Creatinine.
Hyperkalemia, not hypokalemia, is common because the kidneys cannot excrete potassium.
Patients are at high risk for fluid volume excess and hypertension rather than deficit. This
phase requires strict monitoring of electrolytes and fluid intake to prevent pulmonary
edema and cardiac arrhythmias.
5. A nurse is caring for a client with Addison’s disease who is experiencing a stressful event.
Which adjustment to the medication regimen does the nurse expect?
A. Decrease the dose of hydrocortisone.
B. Increase the dose of hydrocortisone.
C. Discontinue fludrocortisone temporarily.
D. Administer insulin to prevent hyperglycemia.
, Correct Answer: B
Rationale: Addison’s disease involves a primary insufficiency of adrenal corticosteroids,
making the body unable to respond adequately to stress. During periods of physical or
emotional stress, the nurse expects the provider to increase the dose of glucocorticoids like
hydrocortisone to prevent an Addisonian crisis. This ‘stress dosing’ mimics the natural
physiological response that occurs in individuals with healthy adrenal glands. Failing to
increase the dose could lead to life-threatening hypotension and cardiovascular collapse.
Patients are taught to carry emergency kits and wear medical alert bracelets for this
reason.
6. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which nursing intervention is most appropriate for this condition?
A. Encouraging oral fluid intake of 3 liters per day.
B. Administering a bolus of 0.45% Sodium Chloride.
C. Monitoring for signs of hypernatremia.
D. Implementing strict fluid restriction.
Correct Answer: D
Rationale: SIADH is characterized by the excessive release of ADH, leading to water
retention and dilutional hyponatremia. The cornerstone of treatment is strict fluid
restriction to prevent further dilution of serum sodium levels. Administering hypotonic
solutions like 0.45% saline would worsen the hyponatremia and is contraindicated. The
nurse must monitor for signs of hyponatremia, such as confusion or seizures, rather than
hypernatremia. Accurate daily weights and intake/output monitoring are essential to
evaluate the effectiveness of the fluid restriction.
7. A patient with Acute Pancreatitis is being admitted. Which laboratory result is the most
specific indicator of pancreatic injury?
A. Serum Amylase 250 U/L
B. Serum Lipase 600 U/L
C. White Blood Cell count 12,000/mm3
D. Serum Calcium 8.2 mg/dL
Correct Answer: B
Rationale: Serum lipase is more specific to the pancreas than amylase and remains
elevated for a longer period. While both amylase and lipase rise during acute pancreatitis,
amylase can also be elevated in cases of mumps or intestinal perforation. Lipase levels
greater than three times the upper limit of normal are highly suggestive of pancreatic
inflammation. Leukocytosis and hypocalcemia are common findings in pancreatitis but are
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with Type 1 Diabetes presents to the ER with a blood glucose of 580 mg/dL,
arterial pH of 7.25, and serum potassium of 3.3 mEq/L. Which provider order should the
nurse prioritize first?
A. Initiate a continuous insulin infusion at 0.1 units/kg/hr.
B. Obtain an electrocardiogram (ECG) and chest X-ray.
C. Administer intravenous potassium chloride 20 mEq.
D. Administer 0.9% Normal Saline at 1000 mL/hr.
Correct Answer: D
Rationale: In Diabetic Ketoacidosis (DKA), the primary concern is severe dehydration and
hypovolemia due to osmotic diuresis. Administering 0.9% Normal Saline is the immediate
priority to restore circulatory volume and improve renal perfusion. While insulin is
necessary to stop ketone production, it should be delayed until fluid resuscitation is
underway and potassium levels are confirmed. Starting insulin before fluids or when
potassium is low can cause a fatal shift of potassium into the cells. Therefore, fluid
resuscitation remains the first-line intervention in the management of DKA.
2. A client with cirrhosis and esophageal varices is being treated with lactulose. Which
laboratory finding indicates that the medication is achieving its therapeutic effect?
A. Decreased prothrombin time (PT)
B. Increased serum albumin level
C. Decreased serum ammonia level
D. Increased serum potassium level
Correct Answer: C
Rationale: Lactulose is an osmotic laxative used primarily in liver failure to reduce the
absorption of ammonia from the gut. It works by acidifying the colon, which converts
ammonia into ammonium, trapping it for excretion in the stool. A decrease in serum
ammonia levels directly correlates with the prevention and treatment of hepatic
encephalopathy. The medication typically causes 2 to 3 soft stools per day, which is the
expected clinical response. Other values like albumin or PT reflect liver synthetic function
and are not directly affected by lactulose.
,3. Following a thyroidectomy, a patient reports numbness and tingling around the mouth and
in the fingertips. What is the nurse’s priority action?
A. Check the patient’s temperature for signs of thyroid storm.
B. Administer oral Levothyroxine as prescribed.
C. Increase the IV rate of D5W and Normal Saline.
D. Assess for Chvostek’s sign and notify the surgeon.
Correct Answer: D
Rationale: Numbness and tingling around the mouth (circumoral paresthesia) are classic
early signs of hypocalcemia, which can occur if the parathyroid glands are accidentally
damaged or removed during a thyroidectomy. The nurse should immediately assess for
Chvostek’s sign or Trousseau’s sign to confirm neuromuscular irritability. Notifying the
surgeon is essential because severe hypocalcemia can lead to laryngospasm and seizures.
Emergency calcium gluconate should be readily available at the bedside for intravenous
administration. While thyroid storm is a concern, the specific symptoms of paresthesia
point directly to calcium imbalance.
4. A patient with Acute Kidney Injury (AKI) enters the oliguric phase. Which clinical
manifestation should the nurse anticipate during this stage?
A. Serum potassium of 3.2 mEq/L
B. BUN and Creatinine elevation
C. Fluid volume deficit and hypotension
D. Increased urine specific gravity
Correct Answer: B
Rationale: The oliguric phase of AKI is characterized by a significant decrease in urine
output, typically less than 400 mL/day. During this phase, the kidneys fail to excrete
metabolic waste, leading to a rise in Blood Urea Nitrogen (BUN) and Creatinine.
Hyperkalemia, not hypokalemia, is common because the kidneys cannot excrete potassium.
Patients are at high risk for fluid volume excess and hypertension rather than deficit. This
phase requires strict monitoring of electrolytes and fluid intake to prevent pulmonary
edema and cardiac arrhythmias.
5. A nurse is caring for a client with Addison’s disease who is experiencing a stressful event.
Which adjustment to the medication regimen does the nurse expect?
A. Decrease the dose of hydrocortisone.
B. Increase the dose of hydrocortisone.
C. Discontinue fludrocortisone temporarily.
D. Administer insulin to prevent hyperglycemia.
, Correct Answer: B
Rationale: Addison’s disease involves a primary insufficiency of adrenal corticosteroids,
making the body unable to respond adequately to stress. During periods of physical or
emotional stress, the nurse expects the provider to increase the dose of glucocorticoids like
hydrocortisone to prevent an Addisonian crisis. This ‘stress dosing’ mimics the natural
physiological response that occurs in individuals with healthy adrenal glands. Failing to
increase the dose could lead to life-threatening hypotension and cardiovascular collapse.
Patients are taught to carry emergency kits and wear medical alert bracelets for this
reason.
6. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which nursing intervention is most appropriate for this condition?
A. Encouraging oral fluid intake of 3 liters per day.
B. Administering a bolus of 0.45% Sodium Chloride.
C. Monitoring for signs of hypernatremia.
D. Implementing strict fluid restriction.
Correct Answer: D
Rationale: SIADH is characterized by the excessive release of ADH, leading to water
retention and dilutional hyponatremia. The cornerstone of treatment is strict fluid
restriction to prevent further dilution of serum sodium levels. Administering hypotonic
solutions like 0.45% saline would worsen the hyponatremia and is contraindicated. The
nurse must monitor for signs of hyponatremia, such as confusion or seizures, rather than
hypernatremia. Accurate daily weights and intake/output monitoring are essential to
evaluate the effectiveness of the fluid restriction.
7. A patient with Acute Pancreatitis is being admitted. Which laboratory result is the most
specific indicator of pancreatic injury?
A. Serum Amylase 250 U/L
B. Serum Lipase 600 U/L
C. White Blood Cell count 12,000/mm3
D. Serum Calcium 8.2 mg/dL
Correct Answer: B
Rationale: Serum lipase is more specific to the pancreas than amylase and remains
elevated for a longer period. While both amylase and lipase rise during acute pancreatitis,
amylase can also be elevated in cases of mumps or intestinal perforation. Lipase levels
greater than three times the upper limit of normal are highly suggestive of pancreatic
inflammation. Leukocytosis and hypocalcemia are common findings in pancreatitis but are
