NUR 3300 Exam 4 V3 | NUR 3300 Nursing
Practice II | Q&A with Rationale (NUR3300
Exam 4) | William Paterson University
1. A patient with Type 1 Diabetes Mellitus presents to the emergency department with
Kussmaul respirations and a fruity breath odor. Which laboratory finding would the nurse
expect to confirm a diagnosis of Diabetic Ketoacidosis (DKA)?
A. Blood glucose 450 mg/dL and bicarbonate level 12 mEq/L
B. Blood glucose 220 mg/dL and arterial pH 7.45
C. Blood glucose 800 mg/dL and absent ketones in urine
D. Serum osmolality greater than 350 mOsm/kg and pH 7.36
Answer: A
Rationale: Diabetic Ketoacidosis is characterized by hyperglycemia, metabolic acidosis,
and the presence of ketones. A bicarbonate level of 12 mEq/L indicates significant
metabolic acidosis, which is a hallmark of this condition. The presence of Kussmaul
respirations is a compensatory mechanism to blow off carbon dioxide and increase the
blood pH.
,2. A nurse is caring for a patient who underwent a total thyroidectomy 12 hours ago. The
patient reports numbness and tingling in the fingertips and around the mouth. What is the
nurse’s priority action?
A. Check the patient’s potassium level
B. Encourage the patient to use an incentive spirometer
C. Assess for Chvostek’s sign and prepare calcium gluconate
D. Administer the prescribed dose of levothyroxine
Answer: C
Rationale: Paresthesia and numbness are early signs of hypocalcemia, which can occur if
the parathyroid glands are accidentally damaged or removed during a thyroidectomy. The
nurse should immediately assess for neuromuscular irritability using Chvostek’s or
Trousseau’s sign to confirm tetany. Having intravenous calcium gluconate available is
critical to prevent life-threatening laryngeal spasms.
3. Which clinical manifestation should the nurse anticipate in a patient diagnosed with
Cushing’s Syndrome?
A. Truncal obesity, buffalo hump, and purple striae
B. Postural hypotension and decreased serum sodium
C. Hyperpigmentation of the skin and weight loss
D. Heat intolerance and exophthalmos
,Answer: A
Rationale: Cushing’s Syndrome results from an excess of corticosteroids, particularly
glucocorticoids. Classic physical findings include central or truncal obesity, a fatty pad
between the shoulders known as a buffalo hump, and thin skin with purple striae. These
changes occur due to the redistribution of body fat and the breakdown of collagen in the
skin.
4. A patient is admitted with Acute Kidney Injury (AKI) and a potassium level of 6.8 mEq/L.
Which medication should the nurse be prepared to administer first to stabilize the cardiac
membrane?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Regular insulin and 50% dextrose
D. Calcium gluconate
Answer: D
Rationale: Severe hyperkalemia (potassium > 6.5 mEq/L) poses a significant risk for lethal
cardiac arrhythmias. Calcium gluconate is administered first to stabilize the cardiac cell
membrane and prevent dysrhythmias, although it does not lower the potassium level itself.
Subsequent treatments like insulin/dextrose or Kayexalate are used to actually shift or
remove potassium from the body.
, 5. A patient with Chronic Kidney Disease (CKD) is receiving erythropoietin injections. What is
the primary therapeutic goal of this medication?
A. Decrease the serum phosphorus level
B. Lower the blood pressure by reducing fluid volume
C. Increase the hemoglobin and hematocrit levels
D. Reduce the accumulation of urea in the blood
Answer: C
Rationale: In CKD, the kidneys fail to produce sufficient erythropoietin, the hormone
responsible for stimulating red blood cell production in the bone marrow. Exogenous
erythropoietin is administered to treat the resulting anemia of chronic disease. Successful
therapy is indicated by an increase in hemoglobin and hematocrit, leading to improved
energy levels and oxygenation.
6. The nurse is providing discharge education to a patient with Addison’s Disease. Which
statement by the patient indicates a need for further teaching?
A. I should wear a medical alert bracelet at all times.
B. I can stop taking my medication once my symptoms improve.
C. I will need to increase my steroid dose during times of stress.
D. I need to notify my doctor if I develop a fever or infection.
Answer: B
Practice II | Q&A with Rationale (NUR3300
Exam 4) | William Paterson University
1. A patient with Type 1 Diabetes Mellitus presents to the emergency department with
Kussmaul respirations and a fruity breath odor. Which laboratory finding would the nurse
expect to confirm a diagnosis of Diabetic Ketoacidosis (DKA)?
A. Blood glucose 450 mg/dL and bicarbonate level 12 mEq/L
B. Blood glucose 220 mg/dL and arterial pH 7.45
C. Blood glucose 800 mg/dL and absent ketones in urine
D. Serum osmolality greater than 350 mOsm/kg and pH 7.36
Answer: A
Rationale: Diabetic Ketoacidosis is characterized by hyperglycemia, metabolic acidosis,
and the presence of ketones. A bicarbonate level of 12 mEq/L indicates significant
metabolic acidosis, which is a hallmark of this condition. The presence of Kussmaul
respirations is a compensatory mechanism to blow off carbon dioxide and increase the
blood pH.
,2. A nurse is caring for a patient who underwent a total thyroidectomy 12 hours ago. The
patient reports numbness and tingling in the fingertips and around the mouth. What is the
nurse’s priority action?
A. Check the patient’s potassium level
B. Encourage the patient to use an incentive spirometer
C. Assess for Chvostek’s sign and prepare calcium gluconate
D. Administer the prescribed dose of levothyroxine
Answer: C
Rationale: Paresthesia and numbness are early signs of hypocalcemia, which can occur if
the parathyroid glands are accidentally damaged or removed during a thyroidectomy. The
nurse should immediately assess for neuromuscular irritability using Chvostek’s or
Trousseau’s sign to confirm tetany. Having intravenous calcium gluconate available is
critical to prevent life-threatening laryngeal spasms.
3. Which clinical manifestation should the nurse anticipate in a patient diagnosed with
Cushing’s Syndrome?
A. Truncal obesity, buffalo hump, and purple striae
B. Postural hypotension and decreased serum sodium
C. Hyperpigmentation of the skin and weight loss
D. Heat intolerance and exophthalmos
,Answer: A
Rationale: Cushing’s Syndrome results from an excess of corticosteroids, particularly
glucocorticoids. Classic physical findings include central or truncal obesity, a fatty pad
between the shoulders known as a buffalo hump, and thin skin with purple striae. These
changes occur due to the redistribution of body fat and the breakdown of collagen in the
skin.
4. A patient is admitted with Acute Kidney Injury (AKI) and a potassium level of 6.8 mEq/L.
Which medication should the nurse be prepared to administer first to stabilize the cardiac
membrane?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Regular insulin and 50% dextrose
D. Calcium gluconate
Answer: D
Rationale: Severe hyperkalemia (potassium > 6.5 mEq/L) poses a significant risk for lethal
cardiac arrhythmias. Calcium gluconate is administered first to stabilize the cardiac cell
membrane and prevent dysrhythmias, although it does not lower the potassium level itself.
Subsequent treatments like insulin/dextrose or Kayexalate are used to actually shift or
remove potassium from the body.
, 5. A patient with Chronic Kidney Disease (CKD) is receiving erythropoietin injections. What is
the primary therapeutic goal of this medication?
A. Decrease the serum phosphorus level
B. Lower the blood pressure by reducing fluid volume
C. Increase the hemoglobin and hematocrit levels
D. Reduce the accumulation of urea in the blood
Answer: C
Rationale: In CKD, the kidneys fail to produce sufficient erythropoietin, the hormone
responsible for stimulating red blood cell production in the bone marrow. Exogenous
erythropoietin is administered to treat the resulting anemia of chronic disease. Successful
therapy is indicated by an increase in hemoglobin and hematocrit, leading to improved
energy levels and oxygenation.
6. The nurse is providing discharge education to a patient with Addison’s Disease. Which
statement by the patient indicates a need for further teaching?
A. I should wear a medical alert bracelet at all times.
B. I can stop taking my medication once my symptoms improve.
C. I will need to increase my steroid dose during times of stress.
D. I need to notify my doctor if I develop a fever or infection.
Answer: B
