Galen NUR 242 Exams 4 – Med-Surg Concepts (2026) Actual Questions and
Answers (PDF).
Questions (1–30) – NUR 242 Med-Surg Concepts Exam 4
1. A patient with diabetic ketoacidosis (DKA) has a serum glucose of 620 mg/dL
and serum potassium of 2.8 mEq/L. Which intervention should the nurse
prioritize?
A. Administer IV potassium before starting insulin
B. Start IV regular insulin bolus immediately
C. Give sodium bicarbonate for acidosis
D. Administer dextrose 50% IV push
Answer: A
Rationale: In DKA, insulin drives potassium into cells, worsening hypokalemia.
Severe hypokalemia must be corrected before insulin therapy to prevent cardiac
arrhythmias.
2. A client with hyperthyroidism is prescribed propylthiouracil (PTU). Which
finding indicates the medication is effective?
A. Weight gain of 4 lbs over 2 weeks
B. Heart rate decrease from 120 to 88 bpm
C. Decreased appetite
,D. Increased sweating and tremors
Answer: B
Rationale: PTU blocks thyroid hormone synthesis; a decreasing heart rate reflects
reduced metabolic demand and effective treatment.
3. A patient post-thyroidectomy reports tingling around the mouth and muscle
twitching. Which lab value should the nurse expect?
A. Hypocalcemia
B. Hyperkalemia
C. Hypernatremia
D. Hypomagnesemia
Answer: A
Rationale: Post-thyroidectomy hypoparathyroidism causes hypocalcemia →
neuromuscular irritability (Chvostek’s/Trousseau’s signs).
4. A nurse is caring for a patient with Cushing’s syndrome. Which finding requires
immediate intervention?
A. Blood glucose 154 mg/dL
,B. Ecchymosis on arms
C. New onset confusion and BP 180/100
D. Moon face and truncal obesity
Answer: C
Rationale: Severe hypertension and confusion may indicate life-threatening
hypertensive crisis or cortisol-induced psychosis/fluid overload.
5. Which complication is the highest priority in a client with acute pancreatitis?
A. Hyperglycemia
B. Hypovolemic shock
C. Pleural effusion
D. Hypercalcemia
Answer: B
Rationale: Third-spacing and hemorrhage can lead to hypovolemic shock, which is
immediately life-threatening.
6. A patient with cirrhosis develops asterixis. What dietary change is most
important?
, A. High-protein supplement
B. Low-sodium diet
C. Protein restriction
D. Fluid restriction
Answer: C
Rationale: Asterixis indicates hepatic encephalopathy; protein breakdown
produces ammonia. Protein restriction reduces ammonia levels.
7. A client on hemodialysis has an AV fistula in the left arm. Which finding
requires reporting to the provider?
A. Palpable thrill
B. Audible bruit
C. Absent pulse distal to fistula
D. Arm swelling with cold fingers
Answer: D
Rationale: Cold fingers and swelling suggest steal syndrome or thrombosis
requiring immediate intervention to salvage the limb/fistula.
Answers (PDF).
Questions (1–30) – NUR 242 Med-Surg Concepts Exam 4
1. A patient with diabetic ketoacidosis (DKA) has a serum glucose of 620 mg/dL
and serum potassium of 2.8 mEq/L. Which intervention should the nurse
prioritize?
A. Administer IV potassium before starting insulin
B. Start IV regular insulin bolus immediately
C. Give sodium bicarbonate for acidosis
D. Administer dextrose 50% IV push
Answer: A
Rationale: In DKA, insulin drives potassium into cells, worsening hypokalemia.
Severe hypokalemia must be corrected before insulin therapy to prevent cardiac
arrhythmias.
2. A client with hyperthyroidism is prescribed propylthiouracil (PTU). Which
finding indicates the medication is effective?
A. Weight gain of 4 lbs over 2 weeks
B. Heart rate decrease from 120 to 88 bpm
C. Decreased appetite
,D. Increased sweating and tremors
Answer: B
Rationale: PTU blocks thyroid hormone synthesis; a decreasing heart rate reflects
reduced metabolic demand and effective treatment.
3. A patient post-thyroidectomy reports tingling around the mouth and muscle
twitching. Which lab value should the nurse expect?
A. Hypocalcemia
B. Hyperkalemia
C. Hypernatremia
D. Hypomagnesemia
Answer: A
Rationale: Post-thyroidectomy hypoparathyroidism causes hypocalcemia →
neuromuscular irritability (Chvostek’s/Trousseau’s signs).
4. A nurse is caring for a patient with Cushing’s syndrome. Which finding requires
immediate intervention?
A. Blood glucose 154 mg/dL
,B. Ecchymosis on arms
C. New onset confusion and BP 180/100
D. Moon face and truncal obesity
Answer: C
Rationale: Severe hypertension and confusion may indicate life-threatening
hypertensive crisis or cortisol-induced psychosis/fluid overload.
5. Which complication is the highest priority in a client with acute pancreatitis?
A. Hyperglycemia
B. Hypovolemic shock
C. Pleural effusion
D. Hypercalcemia
Answer: B
Rationale: Third-spacing and hemorrhage can lead to hypovolemic shock, which is
immediately life-threatening.
6. A patient with cirrhosis develops asterixis. What dietary change is most
important?
, A. High-protein supplement
B. Low-sodium diet
C. Protein restriction
D. Fluid restriction
Answer: C
Rationale: Asterixis indicates hepatic encephalopathy; protein breakdown
produces ammonia. Protein restriction reduces ammonia levels.
7. A client on hemodialysis has an AV fistula in the left arm. Which finding
requires reporting to the provider?
A. Palpable thrill
B. Audible bruit
C. Absent pulse distal to fistula
D. Arm swelling with cold fingers
Answer: D
Rationale: Cold fingers and swelling suggest steal syndrome or thrombosis
requiring immediate intervention to salvage the limb/fistula.
