NUR 242 EXAM 3: ADVANCED MED-
SURG NURSING (ENDOCRINE, RENAL,
AND GI FOCUS)
1. A patient is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). The initial laboratory
results show a serum glucose of 550 mg/dL, a pH of 7.20, and a serum potassium level of 3.4
mEq/L. Which provider order should the nurse implement first?
A. Initiate an intravenous infusion of Regular insulin at 0.1 units/kg/hr.
B. Administer 40 mEq of potassium chloride intravenously in 100 mL of normal saline.
C. Administer sodium bicarbonate via slow IV push.
D. Infuse 0.9% Normal Saline at 1,000 mL/hr.
Answer: D
Conceptual Explanation: Fluid resuscitation is the primary priority in DKA to restore
circulatory volume and perfusion before insulin therapy or electrolyte correction, though
potassium must be addressed quickly as insulin will drive it lower.
,2. A client with Hyperosmolar Hyperglycemic Syndrome (HHS) is receiving treatment. Which
clinical finding best distinguishes HHS from DKA?
A. Presence of Kussmaul respirations and fruity breath odor.
B. Blood glucose level exceeding 600 mg/dL.
C. Absence of significant ketosis and metabolic acidosis.
D. Profound dehydration and neurological changes.
Answer: C
Conceptual Explanation: HHS is characterized by high blood sugar and dehydration
without the significant ketosis or metabolic acidosis found in DKA because there is enough
insulin to prevent fat breakdown.
3. A nurse is caring for a patient who underwent a total thyroidectomy 12 hours ago. The
patient reports tingling in the fingertips and around the mouth. Which action should the
nurse take immediately?
A. Check for Trousseau’s or Chvostek’s sign.
B. Administer the prescribed dose of levothyroxine.
C. Notify the provider that the patient is experiencing normal postoperative anxiety.
D. Assess the surgical site for signs of hemorrhage.
Answer: A
, Conceptual Explanation: Tingling and paresthesia are early signs of hypocalcemia, which
can occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy.
4. Which assessment finding would the nurse expect in a client diagnosed with Cushing’s
Syndrome?
A. Hypotension and hyperkalemia.
B. Bronze-like skin pigmentation and weight loss.
C. Thin, fragile skin and truncal obesity.
D. High serum calcium and bone pain.
Answer: C
Conceptual Explanation: Cushing’s Syndrome is caused by excess cortisol, leading to
characteristic findings like moon face, buffalo hump, truncal obesity, and skin
thinning/striae.
5. A patient with Addison’s disease is experiencing an Addisonian Crisis. Which medication is
the priority to stabilize the patient?
A. Oral fludrocortisone.
B. Intravenous hydrocortisone sodium succinate.
C. Regular insulin and 50% dextrose.
D. Intravenous spironolactone.
SURG NURSING (ENDOCRINE, RENAL,
AND GI FOCUS)
1. A patient is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). The initial laboratory
results show a serum glucose of 550 mg/dL, a pH of 7.20, and a serum potassium level of 3.4
mEq/L. Which provider order should the nurse implement first?
A. Initiate an intravenous infusion of Regular insulin at 0.1 units/kg/hr.
B. Administer 40 mEq of potassium chloride intravenously in 100 mL of normal saline.
C. Administer sodium bicarbonate via slow IV push.
D. Infuse 0.9% Normal Saline at 1,000 mL/hr.
Answer: D
Conceptual Explanation: Fluid resuscitation is the primary priority in DKA to restore
circulatory volume and perfusion before insulin therapy or electrolyte correction, though
potassium must be addressed quickly as insulin will drive it lower.
,2. A client with Hyperosmolar Hyperglycemic Syndrome (HHS) is receiving treatment. Which
clinical finding best distinguishes HHS from DKA?
A. Presence of Kussmaul respirations and fruity breath odor.
B. Blood glucose level exceeding 600 mg/dL.
C. Absence of significant ketosis and metabolic acidosis.
D. Profound dehydration and neurological changes.
Answer: C
Conceptual Explanation: HHS is characterized by high blood sugar and dehydration
without the significant ketosis or metabolic acidosis found in DKA because there is enough
insulin to prevent fat breakdown.
3. A nurse is caring for a patient who underwent a total thyroidectomy 12 hours ago. The
patient reports tingling in the fingertips and around the mouth. Which action should the
nurse take immediately?
A. Check for Trousseau’s or Chvostek’s sign.
B. Administer the prescribed dose of levothyroxine.
C. Notify the provider that the patient is experiencing normal postoperative anxiety.
D. Assess the surgical site for signs of hemorrhage.
Answer: A
, Conceptual Explanation: Tingling and paresthesia are early signs of hypocalcemia, which
can occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy.
4. Which assessment finding would the nurse expect in a client diagnosed with Cushing’s
Syndrome?
A. Hypotension and hyperkalemia.
B. Bronze-like skin pigmentation and weight loss.
C. Thin, fragile skin and truncal obesity.
D. High serum calcium and bone pain.
Answer: C
Conceptual Explanation: Cushing’s Syndrome is caused by excess cortisol, leading to
characteristic findings like moon face, buffalo hump, truncal obesity, and skin
thinning/striae.
5. A patient with Addison’s disease is experiencing an Addisonian Crisis. Which medication is
the priority to stabilize the patient?
A. Oral fludrocortisone.
B. Intravenous hydrocortisone sodium succinate.
C. Regular insulin and 50% dextrose.
D. Intravenous spironolactone.
