GALEN NUR 242 MED-SURG EXAM 3 -
ADVANCED STUDY GUIDE QUESTIONS
AND ANSWERS
1. A patient with SIADH is receiving a 3% hypertonic saline infusion. Which assessment
finding is the priority for the nurse to report to the healthcare provider?
A. Serum sodium level of 128 mEq/L
B. Crackles heard in the lung bases
C. Urine specific gravity of 1.025
D. Complaint of increased thirst
Answer: B
Conceptual Explanation: 3% hypertonic saline is a high-alert medication that can cause
rapid fluid volume overload. Crackles in the lungs indicate pulmonary edema, a life-
threatening complication of fluid overload.
2. Which clinical manifestation would the nurse expect to find in a client diagnosed with
Diabetes Insipidus (DI)?
A. Specific gravity of 1.030
B. Serum sodium of 130 mEq/L
,C. Increased urine osmolality
D. Urine output of 20 liters in 24 hours
Answer: D
Conceptual Explanation: Diabetes Insipidus is characterized by a deficiency of ADH,
leading to massive polyuria (often 5-20 liters per day) and dilute urine with a low specific
gravity (typically <1.005).
3. A client is admitted in an Addisonian Crisis. Which of the following provider orders should
the nurse perform first?
A. Initiate 0.9% Normal Saline at 200 mL/hr
B. Administer 100 mg Hydrocortisone IV bolus
C. Obtain a serum potassium level
D. Administer oral fludrocortisone
Answer: A
Conceptual Explanation: While hydrocortisone is critical, the immediate priority in
Addisonian Crisis is volume resuscitation with IV fluids to treat life-threatening
hypotension and circulatory collapse.
4. A patient with Cushing’s Syndrome is post-operative day 1 after a bilateral adrenalectomy.
What is the most important nursing intervention?
A. Monitor for rapid changes in blood pressure
, B. Maintain strict fluid restriction
C. Monitor for signs of hypoglycemia
D. Encourage a high-sodium diet
Answer: A
Conceptual Explanation: Bilateral adrenalectomy results in an immediate drop in
catecholamines and corticosteroids, putting the patient at high risk for adrenal crisis and
vascular collapse; hemodynamic monitoring is vital.
5. A client is suspected of having a Pheochromocytoma. Which action by the nurse is
contraindicated?
A. Collecting a 24-hour urine for VMA
B. Palpating the abdomen to check for masses
C. Placing the client on a cardiac monitor
D. Monitoring for severe headaches
Answer: B
Conceptual Explanation: Abdominal palpation should be avoided in patients with
pheochromocytoma as it can cause a sudden release of catecholamines, leading to a
hypertensive crisis.
ADVANCED STUDY GUIDE QUESTIONS
AND ANSWERS
1. A patient with SIADH is receiving a 3% hypertonic saline infusion. Which assessment
finding is the priority for the nurse to report to the healthcare provider?
A. Serum sodium level of 128 mEq/L
B. Crackles heard in the lung bases
C. Urine specific gravity of 1.025
D. Complaint of increased thirst
Answer: B
Conceptual Explanation: 3% hypertonic saline is a high-alert medication that can cause
rapid fluid volume overload. Crackles in the lungs indicate pulmonary edema, a life-
threatening complication of fluid overload.
2. Which clinical manifestation would the nurse expect to find in a client diagnosed with
Diabetes Insipidus (DI)?
A. Specific gravity of 1.030
B. Serum sodium of 130 mEq/L
,C. Increased urine osmolality
D. Urine output of 20 liters in 24 hours
Answer: D
Conceptual Explanation: Diabetes Insipidus is characterized by a deficiency of ADH,
leading to massive polyuria (often 5-20 liters per day) and dilute urine with a low specific
gravity (typically <1.005).
3. A client is admitted in an Addisonian Crisis. Which of the following provider orders should
the nurse perform first?
A. Initiate 0.9% Normal Saline at 200 mL/hr
B. Administer 100 mg Hydrocortisone IV bolus
C. Obtain a serum potassium level
D. Administer oral fludrocortisone
Answer: A
Conceptual Explanation: While hydrocortisone is critical, the immediate priority in
Addisonian Crisis is volume resuscitation with IV fluids to treat life-threatening
hypotension and circulatory collapse.
4. A patient with Cushing’s Syndrome is post-operative day 1 after a bilateral adrenalectomy.
What is the most important nursing intervention?
A. Monitor for rapid changes in blood pressure
, B. Maintain strict fluid restriction
C. Monitor for signs of hypoglycemia
D. Encourage a high-sodium diet
Answer: A
Conceptual Explanation: Bilateral adrenalectomy results in an immediate drop in
catecholamines and corticosteroids, putting the patient at high risk for adrenal crisis and
vascular collapse; hemodynamic monitoring is vital.
5. A client is suspected of having a Pheochromocytoma. Which action by the nurse is
contraindicated?
A. Collecting a 24-hour urine for VMA
B. Palpating the abdomen to check for masses
C. Placing the client on a cardiac monitor
D. Monitoring for severe headaches
Answer: B
Conceptual Explanation: Abdominal palpation should be avoided in patients with
pheochromocytoma as it can cause a sudden release of catecholamines, leading to a
hypertensive crisis.
