NRSG 110 Exam 3 V1 | NRSG 110 Medical
Surgical Nursing II | Actual Q&A with
Rationale (NRSG110 Exam 3) | Ivy Tech
1. A nurse is caring for a patient who is 24 hours post-operative following a subtotal
thyroidectomy. The patient reports numbness and tingling around the mouth and in the
fingertips. Which action should the nurse take first?
A. Check the patient’s potassium level.
B. Assess for Chvostek’s or Trousseau’s sign.
C. Administer an oral calcium supplement.
D. Notify the rapid response team immediately.
Correct Answer: B
The patient’s symptoms are classic signs of hypocalcemia, which can occur if the
parathyroid glands are accidentally damaged or removed during a thyroidectomy.
Assessing for Chvostek’s or Trousseau’s sign is the standard clinical method to confirm
neuromuscular irritability associated with low calcium. Once confirmed, the nurse must
notify the provider and anticipate the administration of IV calcium gluconate to prevent
tetany or seizures.
,2. A patient with Type 1 Diabetes Mellitus is admitted with a blood glucose of 580 mg/dL and
a diagnosis of Diabetic Ketoacidosis (DKA). Which of the following clinical manifestations
should the nurse expect to find? (Select all that apply)
A. Kussmaul respirations
B. Fruity breath odor
C. Bradycardia
D. Polyuria and polydipsia
E. Abdominal pain
F. Hypertension
Correct Answer: A,B,D,E
In DKA, the lack of insulin leads to metabolic acidosis, prompting the body to use
Kussmaul respirations to blow off CO2 and compensate. Ketones are produced as fat is
broken down for energy, resulting in a distinct fruity breath odor. Polyuria occurs due to
osmotic diuresis from high glucose, while abdominal pain is a common gastrointestinal
symptom resulting from severe metabolic derangement.
3. The nurse is reviewing the arterial blood gas (ABG) results for a patient with severe chronic
obstructive pulmonary disease (COPD): pH 7.31, PaCO2 55 mmHg, HCO3 28 mEq/L. How
should the nurse interpret these findings?
A. Respiratory acidosis, partially compensated
B. Respiratory alkalosis, uncompensated
,C. Metabolic acidosis, fully compensated
D. Metabolic alkalosis, partially compensated
Correct Answer: A
The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45 mmHg,
which points to a respiratory cause. The HCO3 is also elevated at 28 mEq/L, showing that
the kidneys are attempting to compensate by retaining bicarbonate. Because the pH has not
yet returned to the normal range, the condition is classified as partially compensated
respiratory acidosis.
4. A nurse is educating a patient with Chronic Kidney Disease (CKD) about a low-protein diet.
The patient asks why protein intake must be limited. What is the best response by the nurse?
A. ‘Protein increases the blood pressure, which further damages the nephrons.’
B. ‘A high-protein diet will cause you to lose too much weight.’
C. ‘Limiting protein reduces the accumulation of nitrogenous waste products like urea.’
D. ‘Protein competes with the absorption of your blood pressure medications.’
Correct Answer: C
In CKD, the kidneys are unable to effectively filter out the waste products of protein
metabolism, specifically urea and creatinine. Restricting dietary protein helps minimize the
buildup of these nitrogenous wastes, which reduces symptoms of uremia. This dietary
modification is essential to slow the progression of renal failure and decrease the workload
on the remaining functional nephrons.
, 5. A patient with a history of Cirrhosis is admitted with Hepatic Encephalopathy. The provider
prescribes Lactulose 30 mL orally four times daily. What is the primary purpose of this
medication?
A. To promote the excretion of ammonia through the stool.
B. To prevent gastrointestinal bleeding from esophageal varices.
C. To reduce intracranial pressure.
D. To increase the absorption of fat-soluble vitamins.
Correct Answer: A
Hepatic encephalopathy is caused by the accumulation of ammonia in the blood because
the liver can no longer detoxify it. Lactulose works by creating an acidic environment in the
bowel that converts ammonia into ammonium, which is then trapped and excreted via
frequent bowel movements. The nurse should monitor the patient’s mental status and
ensure they are having 2-3 soft stools per day to confirm the medication’s effectiveness.
6. A patient is diagnosed with Pheochromocytoma. Which clinical manifestation should the
nurse prioritize during the assessment?
A. Bradycardia
B. Hypoglycemia
C. Severe hypertension
D. Weight gain
Surgical Nursing II | Actual Q&A with
Rationale (NRSG110 Exam 3) | Ivy Tech
1. A nurse is caring for a patient who is 24 hours post-operative following a subtotal
thyroidectomy. The patient reports numbness and tingling around the mouth and in the
fingertips. Which action should the nurse take first?
A. Check the patient’s potassium level.
B. Assess for Chvostek’s or Trousseau’s sign.
C. Administer an oral calcium supplement.
D. Notify the rapid response team immediately.
Correct Answer: B
The patient’s symptoms are classic signs of hypocalcemia, which can occur if the
parathyroid glands are accidentally damaged or removed during a thyroidectomy.
Assessing for Chvostek’s or Trousseau’s sign is the standard clinical method to confirm
neuromuscular irritability associated with low calcium. Once confirmed, the nurse must
notify the provider and anticipate the administration of IV calcium gluconate to prevent
tetany or seizures.
,2. A patient with Type 1 Diabetes Mellitus is admitted with a blood glucose of 580 mg/dL and
a diagnosis of Diabetic Ketoacidosis (DKA). Which of the following clinical manifestations
should the nurse expect to find? (Select all that apply)
A. Kussmaul respirations
B. Fruity breath odor
C. Bradycardia
D. Polyuria and polydipsia
E. Abdominal pain
F. Hypertension
Correct Answer: A,B,D,E
In DKA, the lack of insulin leads to metabolic acidosis, prompting the body to use
Kussmaul respirations to blow off CO2 and compensate. Ketones are produced as fat is
broken down for energy, resulting in a distinct fruity breath odor. Polyuria occurs due to
osmotic diuresis from high glucose, while abdominal pain is a common gastrointestinal
symptom resulting from severe metabolic derangement.
3. The nurse is reviewing the arterial blood gas (ABG) results for a patient with severe chronic
obstructive pulmonary disease (COPD): pH 7.31, PaCO2 55 mmHg, HCO3 28 mEq/L. How
should the nurse interpret these findings?
A. Respiratory acidosis, partially compensated
B. Respiratory alkalosis, uncompensated
,C. Metabolic acidosis, fully compensated
D. Metabolic alkalosis, partially compensated
Correct Answer: A
The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45 mmHg,
which points to a respiratory cause. The HCO3 is also elevated at 28 mEq/L, showing that
the kidneys are attempting to compensate by retaining bicarbonate. Because the pH has not
yet returned to the normal range, the condition is classified as partially compensated
respiratory acidosis.
4. A nurse is educating a patient with Chronic Kidney Disease (CKD) about a low-protein diet.
The patient asks why protein intake must be limited. What is the best response by the nurse?
A. ‘Protein increases the blood pressure, which further damages the nephrons.’
B. ‘A high-protein diet will cause you to lose too much weight.’
C. ‘Limiting protein reduces the accumulation of nitrogenous waste products like urea.’
D. ‘Protein competes with the absorption of your blood pressure medications.’
Correct Answer: C
In CKD, the kidneys are unable to effectively filter out the waste products of protein
metabolism, specifically urea and creatinine. Restricting dietary protein helps minimize the
buildup of these nitrogenous wastes, which reduces symptoms of uremia. This dietary
modification is essential to slow the progression of renal failure and decrease the workload
on the remaining functional nephrons.
, 5. A patient with a history of Cirrhosis is admitted with Hepatic Encephalopathy. The provider
prescribes Lactulose 30 mL orally four times daily. What is the primary purpose of this
medication?
A. To promote the excretion of ammonia through the stool.
B. To prevent gastrointestinal bleeding from esophageal varices.
C. To reduce intracranial pressure.
D. To increase the absorption of fat-soluble vitamins.
Correct Answer: A
Hepatic encephalopathy is caused by the accumulation of ammonia in the blood because
the liver can no longer detoxify it. Lactulose works by creating an acidic environment in the
bowel that converts ammonia into ammonium, which is then trapped and excreted via
frequent bowel movements. The nurse should monitor the patient’s mental status and
ensure they are having 2-3 soft stools per day to confirm the medication’s effectiveness.
6. A patient is diagnosed with Pheochromocytoma. Which clinical manifestation should the
nurse prioritize during the assessment?
A. Bradycardia
B. Hypoglycemia
C. Severe hypertension
D. Weight gain
