NU 192 Exam 2 V3 | NU 192 Medical-
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 2) | Galen
1. A nurse is caring for a client who is 24 hours post-thyroidectomy. The client reports a
tingling sensation around the mouth and in the fingertips. Which action should the nurse take
first?
A. Administer an oral calcium carbonate supplement.
B. Check the client’s blood pressure using a sphygmomanometer.
C. Request a stat potassium level from the laboratory.
D. Notify the provider that the client is experiencing normal postoperative anxiety.
Correct Answer: B
Explanation: Tingling around the mouth (circumoral paresthesia) and fingertips is a sign
of hypocalcemia, which can occur if the parathyroid glands are damaged during thyroid
surgery. Checking the blood pressure with a cuff can elicit Trousseau’s sign, a classic
indicator of tetany associated with low calcium levels. The nurse must prioritize
assessment for neuromuscular irritability before implementing interventions or reporting
to the provider.
,2. A nurse is assessing a client with a history of Chronic Kidney Disease (CKD) who is
presenting with fatigue, pruritus, and a pericardial friction rub. Which laboratory findings
should the nurse anticipate? (Select All That Apply)
A. Serum Creatinine 6.2 mg/dL
B. Glomerular Filtration Rate (GFR) 12 mL/min
C. Serum Potassium 3.2 mEq/L
D. Blood Urea Nitrogen (BUN) 85 mg/dL
E. Hemoglobin 14.5 g/dL
F. Serum Phosphorus 5.8 mg/dL
Correct Answer: A, B, D, F
Explanation: Chronic Kidney Disease in late stages involves significant elevations in BUN
and Creatinine due to the inability of the kidneys to filter metabolic waste. A GFR of 12
mL/min indicates Stage 5 CKD, which aligns with the severe symptoms like a pericardial
friction rub (uremic pericarditis). Additionally, hyperphosphatemia is common in renal
failure because the kidneys cannot excrete excess phosphorus efficiently.
3. A client is admitted to the Intensive Care Unit with a diagnosis of Diabetic Ketoacidosis
(DKA). The nurse notes a blood glucose level of 540 mg/dL and a pH of 7.25. Which order
should the nurse implement first?
A. Regular insulin 10 units IV bolus
B. 0.9% Normal Saline infusion at 1,000 mL/hr
,C. Sodium bicarbonate 50 mEq slow IV push
D. Potassium chloride 40 mEq added to the second liter of IV fluids
Correct Answer: B
Explanation: Fluid resuscitation is the immediate priority in DKA to address profound
dehydration and restore circulatory volume. Once volume is being replaced, insulin
therapy is initiated to lower blood glucose and stop ketone production. Delaying fluid
resuscitation can lead to hypovolemic shock and acute renal failure in a client with severe
hyperglycemia.
4. The nurse is monitoring a client’s Cardiac Monitor and observes a rhythm with no
identifiable P waves and an irregularly irregular QRS complex. The client is symptomatic with
a heart rate of 142 bpm. Which medication is most likely to be ordered for rate control?
A. Atropine
B. Diltiazem
C. Epinephrine
D. Lidocaine
Correct Answer: B
Explanation: The description provided describes Atrial Fibrillation with a rapid
ventricular response (RVR). Diltiazem is a calcium channel blocker commonly used to slow
the conduction through the AV node and decrease the heart rate. Rate control is vital to
, prevent hemodynamic instability and maintain adequate cardiac output in symptomatic
patients.
5. Which clinical manifestation would the nurse expect to find in a client diagnosed with
Addison’s disease?
A. Hyperpigmentation of the skin
B. Moon face and buffalo hump
C. Truncal obesity with thin extremities
D. Persistent hypertension and hyperglycemia
Correct Answer: A
Explanation: Addison’s disease is characterized by adrenocortical insufficiency, leading to
low levels of cortisol and aldosterone. The increase in adrenocorticotropic hormone
(ACTH) production results in increased melanin production, causing a ‘bronzed’
appearance or hyperpigmentation. Other common signs include hypotension,
hyponatremia, and hyperkalemia due to the lack of aldosterone.
6. A client with Hyperthyroidism is scheduled for a subtotal thyroidectomy. The nurse
identifies that which of the following are potential symptoms of a Thyroid Storm? (Select All
That Apply)
A. Severe tachycardia
B. Hyperthermia
C. Bradycardia
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 2) | Galen
1. A nurse is caring for a client who is 24 hours post-thyroidectomy. The client reports a
tingling sensation around the mouth and in the fingertips. Which action should the nurse take
first?
A. Administer an oral calcium carbonate supplement.
B. Check the client’s blood pressure using a sphygmomanometer.
C. Request a stat potassium level from the laboratory.
D. Notify the provider that the client is experiencing normal postoperative anxiety.
Correct Answer: B
Explanation: Tingling around the mouth (circumoral paresthesia) and fingertips is a sign
of hypocalcemia, which can occur if the parathyroid glands are damaged during thyroid
surgery. Checking the blood pressure with a cuff can elicit Trousseau’s sign, a classic
indicator of tetany associated with low calcium levels. The nurse must prioritize
assessment for neuromuscular irritability before implementing interventions or reporting
to the provider.
,2. A nurse is assessing a client with a history of Chronic Kidney Disease (CKD) who is
presenting with fatigue, pruritus, and a pericardial friction rub. Which laboratory findings
should the nurse anticipate? (Select All That Apply)
A. Serum Creatinine 6.2 mg/dL
B. Glomerular Filtration Rate (GFR) 12 mL/min
C. Serum Potassium 3.2 mEq/L
D. Blood Urea Nitrogen (BUN) 85 mg/dL
E. Hemoglobin 14.5 g/dL
F. Serum Phosphorus 5.8 mg/dL
Correct Answer: A, B, D, F
Explanation: Chronic Kidney Disease in late stages involves significant elevations in BUN
and Creatinine due to the inability of the kidneys to filter metabolic waste. A GFR of 12
mL/min indicates Stage 5 CKD, which aligns with the severe symptoms like a pericardial
friction rub (uremic pericarditis). Additionally, hyperphosphatemia is common in renal
failure because the kidneys cannot excrete excess phosphorus efficiently.
3. A client is admitted to the Intensive Care Unit with a diagnosis of Diabetic Ketoacidosis
(DKA). The nurse notes a blood glucose level of 540 mg/dL and a pH of 7.25. Which order
should the nurse implement first?
A. Regular insulin 10 units IV bolus
B. 0.9% Normal Saline infusion at 1,000 mL/hr
,C. Sodium bicarbonate 50 mEq slow IV push
D. Potassium chloride 40 mEq added to the second liter of IV fluids
Correct Answer: B
Explanation: Fluid resuscitation is the immediate priority in DKA to address profound
dehydration and restore circulatory volume. Once volume is being replaced, insulin
therapy is initiated to lower blood glucose and stop ketone production. Delaying fluid
resuscitation can lead to hypovolemic shock and acute renal failure in a client with severe
hyperglycemia.
4. The nurse is monitoring a client’s Cardiac Monitor and observes a rhythm with no
identifiable P waves and an irregularly irregular QRS complex. The client is symptomatic with
a heart rate of 142 bpm. Which medication is most likely to be ordered for rate control?
A. Atropine
B. Diltiazem
C. Epinephrine
D. Lidocaine
Correct Answer: B
Explanation: The description provided describes Atrial Fibrillation with a rapid
ventricular response (RVR). Diltiazem is a calcium channel blocker commonly used to slow
the conduction through the AV node and decrease the heart rate. Rate control is vital to
, prevent hemodynamic instability and maintain adequate cardiac output in symptomatic
patients.
5. Which clinical manifestation would the nurse expect to find in a client diagnosed with
Addison’s disease?
A. Hyperpigmentation of the skin
B. Moon face and buffalo hump
C. Truncal obesity with thin extremities
D. Persistent hypertension and hyperglycemia
Correct Answer: A
Explanation: Addison’s disease is characterized by adrenocortical insufficiency, leading to
low levels of cortisol and aldosterone. The increase in adrenocorticotropic hormone
(ACTH) production results in increased melanin production, causing a ‘bronzed’
appearance or hyperpigmentation. Other common signs include hypotension,
hyponatremia, and hyperkalemia due to the lack of aldosterone.
6. A client with Hyperthyroidism is scheduled for a subtotal thyroidectomy. The nurse
identifies that which of the following are potential symptoms of a Thyroid Storm? (Select All
That Apply)
A. Severe tachycardia
B. Hyperthermia
C. Bradycardia
