NR341/NR 341 Exam 3 V1 | Complex Adult Health
Q&A with Rationale | Chamberlain University
1. A patient with Type 1 Diabetes is admitted with a blood glucose of 550 mg/dL, arterial pH
of 7.25, and positive serum ketones. What is the priority nursing intervention?
A. Administering a bolus of intravenous Glucagon
B. Initiating intravenous normal saline infusion
C. Administering subcutaneous long-acting insulin
D. Starting a potassium-restricted diet immediately
Correct Answer: B
Explanation: The priority intervention for Diabetic Ketoacidosis (DKA) is fluid
resuscitation to restore circulatory volume and stabilize the patient. Once fluids are
initiated, an intravenous insulin infusion is usually started to lower blood glucose and stop
ketone production. Potassium levels must be monitored closely because insulin will cause
potassium to shift into the cells, potentially leading to hypokalemia.
2. A client is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which
laboratory finding should the nurse expect?
A. Serum osmolality of 310 mOsm/kg
B. Serum sodium of 120 mEq/L
C. Urine specific gravity of 1.002
,D. Hematocrit of 55%
Correct Answer: B
Explanation: SIADH involves the excessive release of ADH, leading to water retention and
dilutional hyponatremia, evidenced by a low serum sodium level. The serum osmolality
would typically be low rather than high because the blood is diluted. Concentrated urine
with a high specific gravity is expected because the body is retaining water rather than
excreting it.
3. The nurse is caring for a patient in the resuscitation phase of a major burn injury. Which
assessment finding is the most reliable indicator of adequate fluid resuscitation?
A. Systolic blood pressure above 120 mmHg
B. Heart rate of 110 beats per minute
C. Urine output of 0.5 to 1 mL/kg/hr
D. Normal skin turgor in non-burned areas
Correct Answer: C
Explanation: Hourly urine output is the gold standard for assessing the adequacy of fluid
resuscitation in burn patients. While blood pressure and heart rate are important, they can
be affected by the massive stress response and catecholamine release. Maintaining a urine
output of 30-50 mL/hr or 0.5 mL/kg/hr ensures that the kidneys are being adequately
perfused.
,4. A patient with a high fever and tachycardia is suspected of having a thyroid storm. Which
medication should the nurse anticipate administering to block the peripheral conversion of
T4 to T3?
A. Levothyroxine
B. Calcium Gluconate
C. Propylthiouracil (PTU)
D. Regular Insulin
Correct Answer: C
Explanation: Propylthiouracil (PTU) is used in thyroid storm because it inhibits the
synthesis of thyroid hormones and prevents the peripheral conversion of T4 to the more
active T3. This medication is critical in managing the life-threatening hypermetabolic state
associated with thyroid storm. Other treatments may include beta-blockers to manage
heart rate and glucocorticoids to further inhibit hormone conversion.
5. Which clinical manifestation distinguishes Hyperosmolar Hyperglycemic Syndrome (HHS)
from Diabetic Ketoacidosis (DKA)?
A. Significant dehydration and high serum osmolality
B. Blood glucose level of 400 mg/dL
C. Presence of Kussmaul respirations
D. Elevated anion gap and metabolic acidosis
, Correct Answer: A
Explanation: HHS is characterized by profound hyperglycemia and high serum osmolality
without the metabolic acidosis or ketosis seen in DKA. Kussmaul respirations occur in DKA
as the body attempts to blow off carbon dioxide to compensate for metabolic acidosis.
Patients with HHS have enough insulin to prevent fat breakdown into ketones but not
enough to control glucose levels.
6. A patient with Diabetes Insipidus (DI) is receiving Desmopressin (DDAVP). Which finding
indicates the medication is effective?
A. Increased thirst and oral intake
B. Decreased urine specific gravity
C. Increased serum sodium levels
D. Decreased urine output and increased urine specific gravity
Correct Answer: D
Explanation: Desmopressin acts as an antidiuretic hormone, which helps the kidneys
retain water. Effectiveness is demonstrated by a decrease in the excessive urine output
(polyuria) and an increase in the concentration of the urine. If the medication is working,
the patient’s urine specific gravity should move toward the normal range of 1.010 to 1.030.
Q&A with Rationale | Chamberlain University
1. A patient with Type 1 Diabetes is admitted with a blood glucose of 550 mg/dL, arterial pH
of 7.25, and positive serum ketones. What is the priority nursing intervention?
A. Administering a bolus of intravenous Glucagon
B. Initiating intravenous normal saline infusion
C. Administering subcutaneous long-acting insulin
D. Starting a potassium-restricted diet immediately
Correct Answer: B
Explanation: The priority intervention for Diabetic Ketoacidosis (DKA) is fluid
resuscitation to restore circulatory volume and stabilize the patient. Once fluids are
initiated, an intravenous insulin infusion is usually started to lower blood glucose and stop
ketone production. Potassium levels must be monitored closely because insulin will cause
potassium to shift into the cells, potentially leading to hypokalemia.
2. A client is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which
laboratory finding should the nurse expect?
A. Serum osmolality of 310 mOsm/kg
B. Serum sodium of 120 mEq/L
C. Urine specific gravity of 1.002
,D. Hematocrit of 55%
Correct Answer: B
Explanation: SIADH involves the excessive release of ADH, leading to water retention and
dilutional hyponatremia, evidenced by a low serum sodium level. The serum osmolality
would typically be low rather than high because the blood is diluted. Concentrated urine
with a high specific gravity is expected because the body is retaining water rather than
excreting it.
3. The nurse is caring for a patient in the resuscitation phase of a major burn injury. Which
assessment finding is the most reliable indicator of adequate fluid resuscitation?
A. Systolic blood pressure above 120 mmHg
B. Heart rate of 110 beats per minute
C. Urine output of 0.5 to 1 mL/kg/hr
D. Normal skin turgor in non-burned areas
Correct Answer: C
Explanation: Hourly urine output is the gold standard for assessing the adequacy of fluid
resuscitation in burn patients. While blood pressure and heart rate are important, they can
be affected by the massive stress response and catecholamine release. Maintaining a urine
output of 30-50 mL/hr or 0.5 mL/kg/hr ensures that the kidneys are being adequately
perfused.
,4. A patient with a high fever and tachycardia is suspected of having a thyroid storm. Which
medication should the nurse anticipate administering to block the peripheral conversion of
T4 to T3?
A. Levothyroxine
B. Calcium Gluconate
C. Propylthiouracil (PTU)
D. Regular Insulin
Correct Answer: C
Explanation: Propylthiouracil (PTU) is used in thyroid storm because it inhibits the
synthesis of thyroid hormones and prevents the peripheral conversion of T4 to the more
active T3. This medication is critical in managing the life-threatening hypermetabolic state
associated with thyroid storm. Other treatments may include beta-blockers to manage
heart rate and glucocorticoids to further inhibit hormone conversion.
5. Which clinical manifestation distinguishes Hyperosmolar Hyperglycemic Syndrome (HHS)
from Diabetic Ketoacidosis (DKA)?
A. Significant dehydration and high serum osmolality
B. Blood glucose level of 400 mg/dL
C. Presence of Kussmaul respirations
D. Elevated anion gap and metabolic acidosis
, Correct Answer: A
Explanation: HHS is characterized by profound hyperglycemia and high serum osmolality
without the metabolic acidosis or ketosis seen in DKA. Kussmaul respirations occur in DKA
as the body attempts to blow off carbon dioxide to compensate for metabolic acidosis.
Patients with HHS have enough insulin to prevent fat breakdown into ketones but not
enough to control glucose levels.
6. A patient with Diabetes Insipidus (DI) is receiving Desmopressin (DDAVP). Which finding
indicates the medication is effective?
A. Increased thirst and oral intake
B. Decreased urine specific gravity
C. Increased serum sodium levels
D. Decreased urine output and increased urine specific gravity
Correct Answer: D
Explanation: Desmopressin acts as an antidiuretic hormone, which helps the kidneys
retain water. Effectiveness is demonstrated by a decrease in the excessive urine output
(polyuria) and an increase in the concentration of the urine. If the medication is working,
the patient’s urine specific gravity should move toward the normal range of 1.010 to 1.030.
