NUR 170 Exam 4 V3 | NUR 170 Medical-Surgical Nursing | Actual Q&A
with Rationale (NUR 170 Exam 4) | Galen
1. A 62-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD)
is admitted with increased shortness of breath and productive cough. His arterial blood gas
(ABG) results are: pH 7.31, PaCO2 52 mmHg, and HCO3 26 mEq/L. Which acid-base imbalance
is this patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The patient’s pH is below 7.35, indicating acidosis, and the PaCO2 is elevated
above 45 mmHg, which points to a respiratory cause. The bicarbonate level is within the
normal range, indicating that the kidneys have not yet compensated for the respiratory
distress. This clinical picture is consistent with hypoventilation seen in acute exacerbations
of COPD.
2. A nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
numbness and tingling in their fingers and around the mouth. What is the nurse’s priority
action?
A. Check the surgical site for bleeding
B. Administer an oral potassium supplement
C. Assess for a positive Chvostek’s sign
D. Notify the provider of potential vocal cord damage
Answer: C
Rationale: Numbness and tingling (paresthesia) are early signs of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy. Assessing for Chvostek’s sign helps confirm neuromuscular irritability
associated with low calcium levels. The nurse should then be prepared to administer
calcium gluconate intravenously as ordered.
3. A patient with Type 1 Diabetes Mellitus is admitted to the emergency department with
fruity-smelling breath, a blood glucose of 550 mg/dL, and Kussmaul respirations. Which IV
solution should the nurse anticipate as the initial order?
A. 0.45% Normal Saline
,B. Dextrose 5% in 0.9% Normal Saline
C. Dextrose 5% in Water
D. 0.9% Normal Saline
Answer: D
Rationale: In Diabetic Ketoacidosis (DKA), the priority is to restore extracellular fluid
volume to maintain perfusion. 0.9% Normal Saline is an isotonic solution used for rapid
fluid resuscitation to treat dehydration and hypotension. Once the blood glucose levels
drop to around 250 mg/dL, the nurse will transition to a dextrose-containing solution to
prevent hypoglycemia and cerebral edema.
4. A nurse is providing discharge education to a patient newly diagnosed with Addison’s
disease. Which instruction is most critical for the nurse to include?
A. Double or triple medication doses during times of high stress
B. Limit sodium intake to less than 2 grams per day
C. Stop the medication immediately if weight gain occurs
D. Restrict fluid intake to 1 liter daily
Answer: A
Rationale: Patients with Addison’s disease have an adrenal insufficiency and cannot
produce extra cortisol during stress, which can lead to an Addisonian crisis. They must be
taught to increase their steroid dosage during illness, trauma, or emotional stress as
directed by their provider. Patients should also carry an emergency kit with injectable
hydrocortisone.
5. An 80-year-old female is admitted with a diagnosis of Acute Kidney Injury (AKI) secondary
to dehydration. Her serum potassium is 6.2 mEq/L. Which medication should the nurse
anticipate administering to protect the heart from the effects of hyperkalemia?
A. Sodium Polystyrene Sulfonate
B. Insulin and Dextrose
C. Calcium Gluconate
D. Furosemide
Answer: C
Rationale: Calcium gluconate does not lower potassium levels but is used to stabilize the
myocardial cell membrane to prevent lethal arrhythmias. While sodium polystyrene
sulfonate and insulin/dextrose are used to actually lower the potassium level, they do not
provide immediate cardiac protection. This is a priority intervention when the potassium is
significantly elevated and causing ECG changes.
, 6. A patient with cirrhosis and ascites is scheduled for a paracentesis. What is the most
important nursing intervention prior to the procedure?
A. Instruct the patient to empty their bladder
B. Maintain the patient in a supine position
C. Administer 1000 mL of IV fluids rapidly
D. Assess the patient’s gag reflex
Answer: A
Rationale: The patient must void before a paracentesis to shrink the bladder and move it
out of the path of the needle, reducing the risk of bladder perforation. The procedure is
typically performed with the patient in a High-Fowler’s position or sitting on the edge of
the bed. Baseline vital signs and weight are also recorded for post-procedure comparison.
7. A nurse is assessing a patient with Cushing’s syndrome. Which clinical manifestation should
the nurse expect to find?
A. Postural hypotension
B. Hyperpigmentation of the skin
C. Truncal obesity and moon face
D. Weight loss and anorexia
Answer: C
Rationale: Cushing’s syndrome is characterized by an excess of corticosteroids,
particularly cortisol. This leads to fat redistribution resulting in truncal obesity, a ‘buffalo
hump,’ and a ‘moon face.’ Other symptoms include purple striae, thin skin, and
hypertension.
8. A patient is admitted with a suspected bowel obstruction. Which assessment finding would
the nurse consider a late sign of a small bowel obstruction?
A. Abdominal distention
B. High-pitched bowel sounds
C. Fecal-smelling emesis
D. Colicky abdominal pain
Answer: C
Rationale: Fecal-smelling emesis (feculent vomiting) occurs late in a small bowel
obstruction when intestinal contents are pushed back up into the stomach. Early signs
include abdominal pain, distention, and hyperactive bowel sounds above the obstruction.
Monitoring for signs of dehydration and electrolyte imbalance is crucial in these patients.
with Rationale (NUR 170 Exam 4) | Galen
1. A 62-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD)
is admitted with increased shortness of breath and productive cough. His arterial blood gas
(ABG) results are: pH 7.31, PaCO2 52 mmHg, and HCO3 26 mEq/L. Which acid-base imbalance
is this patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The patient’s pH is below 7.35, indicating acidosis, and the PaCO2 is elevated
above 45 mmHg, which points to a respiratory cause. The bicarbonate level is within the
normal range, indicating that the kidneys have not yet compensated for the respiratory
distress. This clinical picture is consistent with hypoventilation seen in acute exacerbations
of COPD.
2. A nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
numbness and tingling in their fingers and around the mouth. What is the nurse’s priority
action?
A. Check the surgical site for bleeding
B. Administer an oral potassium supplement
C. Assess for a positive Chvostek’s sign
D. Notify the provider of potential vocal cord damage
Answer: C
Rationale: Numbness and tingling (paresthesia) are early signs of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy. Assessing for Chvostek’s sign helps confirm neuromuscular irritability
associated with low calcium levels. The nurse should then be prepared to administer
calcium gluconate intravenously as ordered.
3. A patient with Type 1 Diabetes Mellitus is admitted to the emergency department with
fruity-smelling breath, a blood glucose of 550 mg/dL, and Kussmaul respirations. Which IV
solution should the nurse anticipate as the initial order?
A. 0.45% Normal Saline
,B. Dextrose 5% in 0.9% Normal Saline
C. Dextrose 5% in Water
D. 0.9% Normal Saline
Answer: D
Rationale: In Diabetic Ketoacidosis (DKA), the priority is to restore extracellular fluid
volume to maintain perfusion. 0.9% Normal Saline is an isotonic solution used for rapid
fluid resuscitation to treat dehydration and hypotension. Once the blood glucose levels
drop to around 250 mg/dL, the nurse will transition to a dextrose-containing solution to
prevent hypoglycemia and cerebral edema.
4. A nurse is providing discharge education to a patient newly diagnosed with Addison’s
disease. Which instruction is most critical for the nurse to include?
A. Double or triple medication doses during times of high stress
B. Limit sodium intake to less than 2 grams per day
C. Stop the medication immediately if weight gain occurs
D. Restrict fluid intake to 1 liter daily
Answer: A
Rationale: Patients with Addison’s disease have an adrenal insufficiency and cannot
produce extra cortisol during stress, which can lead to an Addisonian crisis. They must be
taught to increase their steroid dosage during illness, trauma, or emotional stress as
directed by their provider. Patients should also carry an emergency kit with injectable
hydrocortisone.
5. An 80-year-old female is admitted with a diagnosis of Acute Kidney Injury (AKI) secondary
to dehydration. Her serum potassium is 6.2 mEq/L. Which medication should the nurse
anticipate administering to protect the heart from the effects of hyperkalemia?
A. Sodium Polystyrene Sulfonate
B. Insulin and Dextrose
C. Calcium Gluconate
D. Furosemide
Answer: C
Rationale: Calcium gluconate does not lower potassium levels but is used to stabilize the
myocardial cell membrane to prevent lethal arrhythmias. While sodium polystyrene
sulfonate and insulin/dextrose are used to actually lower the potassium level, they do not
provide immediate cardiac protection. This is a priority intervention when the potassium is
significantly elevated and causing ECG changes.
, 6. A patient with cirrhosis and ascites is scheduled for a paracentesis. What is the most
important nursing intervention prior to the procedure?
A. Instruct the patient to empty their bladder
B. Maintain the patient in a supine position
C. Administer 1000 mL of IV fluids rapidly
D. Assess the patient’s gag reflex
Answer: A
Rationale: The patient must void before a paracentesis to shrink the bladder and move it
out of the path of the needle, reducing the risk of bladder perforation. The procedure is
typically performed with the patient in a High-Fowler’s position or sitting on the edge of
the bed. Baseline vital signs and weight are also recorded for post-procedure comparison.
7. A nurse is assessing a patient with Cushing’s syndrome. Which clinical manifestation should
the nurse expect to find?
A. Postural hypotension
B. Hyperpigmentation of the skin
C. Truncal obesity and moon face
D. Weight loss and anorexia
Answer: C
Rationale: Cushing’s syndrome is characterized by an excess of corticosteroids,
particularly cortisol. This leads to fat redistribution resulting in truncal obesity, a ‘buffalo
hump,’ and a ‘moon face.’ Other symptoms include purple striae, thin skin, and
hypertension.
8. A patient is admitted with a suspected bowel obstruction. Which assessment finding would
the nurse consider a late sign of a small bowel obstruction?
A. Abdominal distention
B. High-pitched bowel sounds
C. Fecal-smelling emesis
D. Colicky abdominal pain
Answer: C
Rationale: Fecal-smelling emesis (feculent vomiting) occurs late in a small bowel
obstruction when intestinal contents are pushed back up into the stomach. Early signs
include abdominal pain, distention, and hyperactive bowel sounds above the obstruction.
Monitoring for signs of dehydration and electrolyte imbalance is crucial in these patients.
