,NUR 201 Midterm Exam Medical-Surgical Nursing I Questions And
Answers 2026/2027 Jersey College
Q1. Which laboratory pattern is most consistent with syndrome of
inappropriate antidiuretic hormone secretion (SIADH)?
A) High serum osmolality with dilute urine
B) Low serum sodium with concentrated urine
C) High serum sodium with excessive urine output
D) Elevated hematocrit with very low urine specific gravity
Correct Answer: B) Low serum sodium with concentrated urine
Rationale: Excess ADH causes inappropriate water retention, diluting serum
sodium and lowering serum osmolality while the kidneys continue producing
relatively concentrated urine.
Q2. A patient with diabetes insipidus has a urine output of 350
mL/hr for several consecutive hours. Which complication is the
greatest immediate concern?
A) Fluid-volume excess
B) Pulmonary edema
C) Dilutional hyponatremia
D) Severe dehydration and hypernatremia
Correct Answer: D) Severe dehydration and hypernatremia
Rationale: Diabetes insipidus causes loss of large quantities of dilute urine.
Without adequate replacement, water loss can rapidly produce hypovolemia,
dehydration, and elevated serum sodium.
Q3. Desmopressin is prescribed for central diabetes insipidus.
Which finding best indicates that treatment is effective?
A) Urine output decreases and urine becomes more concentrated
B) Serum sodium rises progressively
C) Thirst and polyuria become more severe
D) Urine specific gravity falls further
Correct Answer: A) Urine output decreases and urine becomes more
concentrated
Rationale: Desmopressin replaces deficient antidiuretic activity, promoting
renal water reabsorption and reducing the excessive production of dilute
urine.
,Q4. Which intervention is most appropriate for a neurologically
stable patient with SIADH and moderate dilutional hyponatremia?
A) Encourage several liters of free water daily
B) Administer hypotonic fluids rapidly
C) Restrict fluid intake as prescribed
D) Encourage a sodium-free diet
Correct Answer: C) Restrict fluid intake as prescribed
Rationale: Fluid restriction reduces further water retention and helps
gradually correct dilutional hyponatremia in SIADH when severe neurologic
symptoms do not require more aggressive treatment.
Q5. Which hormone is released from the posterior pituitary gland?
A) Thyroid-stimulating hormone
B) Antidiuretic hormone
C) Adrenocorticotropic hormone
D) Prolactin
Correct Answer: B) Antidiuretic hormone
Rationale: ADH is synthesized in the hypothalamus and transported to the
posterior pituitary, where it is stored and released into the circulation.
Q6. A patient with SIADH becomes increasingly confused and
develops muscle twitching. Which laboratory value should receive
the greatest attention?
A) Serum sodium
B) Serum cholesterol
C) Hemoglobin A1C
D) Serum bilirubin
Correct Answer: A) Serum sodium
Rationale: Neurologic deterioration in SIADH may indicate severe
hyponatremia. Rapidly declining sodium can cause cerebral edema, seizures,
and coma.
Q7. What physiologic effect should occur when antidiuretic hormone
secretion increases appropriately?
A) Increased sodium excretion with massive diuresis
B) Decreased renal water reabsorption
, C) Increased urinary water loss
D) Increased water reabsorption in the renal collecting system
Correct Answer: D) Increased water reabsorption in the renal collecting
system
Rationale: ADH increases permeability of the distal nephron and collecting
ducts to water, allowing water to be reabsorbed and urine to become more
concentrated.
Q8. A patient develops diabetes insipidus following pituitary
surgery. Which assessment pattern is expected?
A) Oliguria, edema, and low serum sodium
B) Concentrated urine and weight gain
C) Polyuria, intense thirst, and dilute urine
D) Hypertension and water intoxication
Correct Answer: C) Polyuria, intense thirst, and dilute urine
Rationale: Loss of adequate ADH activity prevents normal water
conservation, resulting in excessive dilute urine, compensatory thirst, and
risk of dehydration.
Q9. Which anterior pituitary hormone stimulates the adrenal cortex
to release cortisol?
A) Adrenocorticotropic hormone
B) Growth hormone
C) Antidiuretic hormone
D) Oxytocin
Correct Answer: A) Adrenocorticotropic hormone
Rationale: ACTH is released by the anterior pituitary and stimulates cortisol
production by the adrenal cortex.
Q10. A patient with severe SIADH has a serum sodium of 116 mEq/L
and develops seizures. Which treatment may be required under
close monitoring?
A) Large amounts of oral free water
B) Carefully controlled hypertonic saline
C) Continuous hypotonic IV fluid
D) Potassium restriction alone
Answers 2026/2027 Jersey College
Q1. Which laboratory pattern is most consistent with syndrome of
inappropriate antidiuretic hormone secretion (SIADH)?
A) High serum osmolality with dilute urine
B) Low serum sodium with concentrated urine
C) High serum sodium with excessive urine output
D) Elevated hematocrit with very low urine specific gravity
Correct Answer: B) Low serum sodium with concentrated urine
Rationale: Excess ADH causes inappropriate water retention, diluting serum
sodium and lowering serum osmolality while the kidneys continue producing
relatively concentrated urine.
Q2. A patient with diabetes insipidus has a urine output of 350
mL/hr for several consecutive hours. Which complication is the
greatest immediate concern?
A) Fluid-volume excess
B) Pulmonary edema
C) Dilutional hyponatremia
D) Severe dehydration and hypernatremia
Correct Answer: D) Severe dehydration and hypernatremia
Rationale: Diabetes insipidus causes loss of large quantities of dilute urine.
Without adequate replacement, water loss can rapidly produce hypovolemia,
dehydration, and elevated serum sodium.
Q3. Desmopressin is prescribed for central diabetes insipidus.
Which finding best indicates that treatment is effective?
A) Urine output decreases and urine becomes more concentrated
B) Serum sodium rises progressively
C) Thirst and polyuria become more severe
D) Urine specific gravity falls further
Correct Answer: A) Urine output decreases and urine becomes more
concentrated
Rationale: Desmopressin replaces deficient antidiuretic activity, promoting
renal water reabsorption and reducing the excessive production of dilute
urine.
,Q4. Which intervention is most appropriate for a neurologically
stable patient with SIADH and moderate dilutional hyponatremia?
A) Encourage several liters of free water daily
B) Administer hypotonic fluids rapidly
C) Restrict fluid intake as prescribed
D) Encourage a sodium-free diet
Correct Answer: C) Restrict fluid intake as prescribed
Rationale: Fluid restriction reduces further water retention and helps
gradually correct dilutional hyponatremia in SIADH when severe neurologic
symptoms do not require more aggressive treatment.
Q5. Which hormone is released from the posterior pituitary gland?
A) Thyroid-stimulating hormone
B) Antidiuretic hormone
C) Adrenocorticotropic hormone
D) Prolactin
Correct Answer: B) Antidiuretic hormone
Rationale: ADH is synthesized in the hypothalamus and transported to the
posterior pituitary, where it is stored and released into the circulation.
Q6. A patient with SIADH becomes increasingly confused and
develops muscle twitching. Which laboratory value should receive
the greatest attention?
A) Serum sodium
B) Serum cholesterol
C) Hemoglobin A1C
D) Serum bilirubin
Correct Answer: A) Serum sodium
Rationale: Neurologic deterioration in SIADH may indicate severe
hyponatremia. Rapidly declining sodium can cause cerebral edema, seizures,
and coma.
Q7. What physiologic effect should occur when antidiuretic hormone
secretion increases appropriately?
A) Increased sodium excretion with massive diuresis
B) Decreased renal water reabsorption
, C) Increased urinary water loss
D) Increased water reabsorption in the renal collecting system
Correct Answer: D) Increased water reabsorption in the renal collecting
system
Rationale: ADH increases permeability of the distal nephron and collecting
ducts to water, allowing water to be reabsorbed and urine to become more
concentrated.
Q8. A patient develops diabetes insipidus following pituitary
surgery. Which assessment pattern is expected?
A) Oliguria, edema, and low serum sodium
B) Concentrated urine and weight gain
C) Polyuria, intense thirst, and dilute urine
D) Hypertension and water intoxication
Correct Answer: C) Polyuria, intense thirst, and dilute urine
Rationale: Loss of adequate ADH activity prevents normal water
conservation, resulting in excessive dilute urine, compensatory thirst, and
risk of dehydration.
Q9. Which anterior pituitary hormone stimulates the adrenal cortex
to release cortisol?
A) Adrenocorticotropic hormone
B) Growth hormone
C) Antidiuretic hormone
D) Oxytocin
Correct Answer: A) Adrenocorticotropic hormone
Rationale: ACTH is released by the anterior pituitary and stimulates cortisol
production by the adrenal cortex.
Q10. A patient with severe SIADH has a serum sodium of 116 mEq/L
and develops seizures. Which treatment may be required under
close monitoring?
A) Large amounts of oral free water
B) Carefully controlled hypertonic saline
C) Continuous hypotonic IV fluid
D) Potassium restriction alone
