NSG 320 Exam 4 V3 | NSG 320 Adult
Health Nursing I | Actual Q&A with
Rationale (NSG320 Exam 4) | Grand
Canyon University
1. A nurse is teaching a patient with Stage 4 Chronic Kidney Disease (CKD) about dietary
restrictions to manage electrolyte levels. Which food items should the patient be instructed
to limit or avoid? (Select all that apply)
A. Bananas
B. Spinach
C. White rice
D. Deli meats
E. Canned soups
F. Orange juice
Correct Answer: A, B, D, E, F
Explanation: Patients with Stage 4 CKD must strictly monitor their intake of potassium,
sodium, and phosphorus to prevent life-threatening imbalances. Bananas, spinach, and
orange juice are high in potassium, which can lead to hyperkalemia as renal excretion
decreases. Deli meats and canned soups are typically high in sodium and phosphorus,
,which contribute to fluid retention and mineral bone disorders. White rice is generally
considered a low-potassium carbohydrate and is safer for this population.
2. A patient is admitted to the emergency department with Diabetic Ketoacidosis (DKA).
Which of the following healthcare provider orders should the nurse implement first?
A. Administer 10 units of regular insulin IV bolus.
B. Obtain an arterial blood gas (ABG) sample.
C. Start an infusion of 0.9% Normal Saline at 1,000 mL/hr.
D. Administer potassium chloride 20 mEq IV push.
Correct Answer: C
Explanation: The priority intervention in the management of DKA is fluid resuscitation to
restore circulatory volume and improve renal perfusion. While insulin is necessary to
correct hyperglycemia and acidosis, it should follow initial volume expansion to prevent
vascular collapse. Never administer potassium IV push, as this is fatal; it must be diluted
and given over time after confirming adequate urine output.
3. The nurse is caring for a patient who is 12 hours post-thyroidectomy. The patient reports a
tingling sensation around the mouth and in the fingertips. Which action should the nurse take
next?
A. Assess for Chvostek’s or Trousseau’s sign.
B. Check the patient’s potassium level.
C. Notify the surgeon that the patient is experiencing normal postoperative anxiety.
,D. Administer a PRN dose of oral calcium carbonate.
Correct Answer: A
Explanation: Tingling around the mouth (circumoral paresthesia) and in the fingertips 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 neuromuscular irritability using Chvostek’s sign (facial twitching) or Trousseau’s
sign (carpal spasm with BP cuff inflation). Following assessment, the nurse should notify
the provider and prepare to administer intravenous calcium gluconate if ordered.
4. Which clinical finding is most characteristic of the oliguric phase of Acute Kidney Injury
(AKI)?
A. Daily urine output of 1,500 mL.
B. Fixed urine specific gravity of 1.010.
C. Serum creatinine level of 0.8 mg/dL.
D. Metabolic alkalosis.
Correct Answer: B
Explanation: In the oliguric phase of AKI, the kidneys lose the ability to concentrate urine,
leading to a fixed specific gravity of approximately 1.010, which mirrors the osmolarity of
plasma. Oliguria is defined as urine output less than 400 mL per day. Patients in this phase
typically experience metabolic acidosis and rising serum creatinine levels due to the
accumulation of waste products.
, 5. A patient with a history of Addison’s disease is admitted with a fever and lethargy. The
nurse should monitor the patient for which signs of an Addisonian Crisis? (Select all that
apply)
A. Severe hypotension
B. Hyperglycemia
C. Hyponatremia
D. Hyperkalemia
E. Tachycardia
Correct Answer: A, C, D, E
Explanation: Addisonian crisis is a life-threatening emergency caused by a severe
deficiency of cortisol and aldosterone, often triggered by stress or infection. Typical
findings include profound hypotension leading to shock, hyponatremia, and hyperkalemia.
Hyperglycemia is not expected; instead, hypoglycemia is common because cortisol is
necessary for gluconeogenesis.
6. The nurse is monitoring a patient undergoing peritoneal dialysis. The nurse notes that the
dialysate drainage is cloudy. What is the nurse’s priority action?
A. Notify the healthcare provider and obtain a sample for culture.
B. Reposition the patient to improve drainage.
C. Document the finding as normal.
Health Nursing I | Actual Q&A with
Rationale (NSG320 Exam 4) | Grand
Canyon University
1. A nurse is teaching a patient with Stage 4 Chronic Kidney Disease (CKD) about dietary
restrictions to manage electrolyte levels. Which food items should the patient be instructed
to limit or avoid? (Select all that apply)
A. Bananas
B. Spinach
C. White rice
D. Deli meats
E. Canned soups
F. Orange juice
Correct Answer: A, B, D, E, F
Explanation: Patients with Stage 4 CKD must strictly monitor their intake of potassium,
sodium, and phosphorus to prevent life-threatening imbalances. Bananas, spinach, and
orange juice are high in potassium, which can lead to hyperkalemia as renal excretion
decreases. Deli meats and canned soups are typically high in sodium and phosphorus,
,which contribute to fluid retention and mineral bone disorders. White rice is generally
considered a low-potassium carbohydrate and is safer for this population.
2. A patient is admitted to the emergency department with Diabetic Ketoacidosis (DKA).
Which of the following healthcare provider orders should the nurse implement first?
A. Administer 10 units of regular insulin IV bolus.
B. Obtain an arterial blood gas (ABG) sample.
C. Start an infusion of 0.9% Normal Saline at 1,000 mL/hr.
D. Administer potassium chloride 20 mEq IV push.
Correct Answer: C
Explanation: The priority intervention in the management of DKA is fluid resuscitation to
restore circulatory volume and improve renal perfusion. While insulin is necessary to
correct hyperglycemia and acidosis, it should follow initial volume expansion to prevent
vascular collapse. Never administer potassium IV push, as this is fatal; it must be diluted
and given over time after confirming adequate urine output.
3. The nurse is caring for a patient who is 12 hours post-thyroidectomy. The patient reports a
tingling sensation around the mouth and in the fingertips. Which action should the nurse take
next?
A. Assess for Chvostek’s or Trousseau’s sign.
B. Check the patient’s potassium level.
C. Notify the surgeon that the patient is experiencing normal postoperative anxiety.
,D. Administer a PRN dose of oral calcium carbonate.
Correct Answer: A
Explanation: Tingling around the mouth (circumoral paresthesia) and in the fingertips 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 neuromuscular irritability using Chvostek’s sign (facial twitching) or Trousseau’s
sign (carpal spasm with BP cuff inflation). Following assessment, the nurse should notify
the provider and prepare to administer intravenous calcium gluconate if ordered.
4. Which clinical finding is most characteristic of the oliguric phase of Acute Kidney Injury
(AKI)?
A. Daily urine output of 1,500 mL.
B. Fixed urine specific gravity of 1.010.
C. Serum creatinine level of 0.8 mg/dL.
D. Metabolic alkalosis.
Correct Answer: B
Explanation: In the oliguric phase of AKI, the kidneys lose the ability to concentrate urine,
leading to a fixed specific gravity of approximately 1.010, which mirrors the osmolarity of
plasma. Oliguria is defined as urine output less than 400 mL per day. Patients in this phase
typically experience metabolic acidosis and rising serum creatinine levels due to the
accumulation of waste products.
, 5. A patient with a history of Addison’s disease is admitted with a fever and lethargy. The
nurse should monitor the patient for which signs of an Addisonian Crisis? (Select all that
apply)
A. Severe hypotension
B. Hyperglycemia
C. Hyponatremia
D. Hyperkalemia
E. Tachycardia
Correct Answer: A, C, D, E
Explanation: Addisonian crisis is a life-threatening emergency caused by a severe
deficiency of cortisol and aldosterone, often triggered by stress or infection. Typical
findings include profound hypotension leading to shock, hyponatremia, and hyperkalemia.
Hyperglycemia is not expected; instead, hypoglycemia is common because cortisol is
necessary for gluconeogenesis.
6. The nurse is monitoring a patient undergoing peritoneal dialysis. The nurse notes that the
dialysate drainage is cloudy. What is the nurse’s priority action?
A. Notify the healthcare provider and obtain a sample for culture.
B. Reposition the patient to improve drainage.
C. Document the finding as normal.
