NU 157 Exam 4 V3 | NU 157 Medical-
Surgical Nursing I-A | NCLEX (NGN) Q&A
with Rationale (NU157 Exam 4) | Galen
1. A nurse is assessing a client who has a suspected diagnosis of hypoglycemia. Which clinical
manifestations should the nurse expect to observe? (Select All That Apply)
A. Diaphoresis
B. Palpitations
C. Increased thirst
D. Irritability
E. Confusion
F. Abdominal pain
Correct Answer: A, B, D, E
Explanation: Hypoglycemia triggers the sympathetic nervous system, leading to symptoms
such as diaphoresis, palpitations, and tremors. Neurological symptoms like irritability and
confusion occur as the brain is deprived of necessary glucose. Increased thirst and
abdominal pain are more characteristic of hyperglycemia and diabetic ketoacidosis.
2. A client with type 1 diabetes mellitus is prescribed a combination of NPH and Regular
insulin. Which action by the nurse is correct when preparing these insulins in a single syringe?
A. Draw up the NPH insulin first, followed by the Regular insulin.
,B. Shake the NPH vial vigorously to ensure the suspension is mixed.
C. Draw up the Regular insulin first, followed by the NPH insulin.
D. Inject air into the Regular vial first, then into the NPH vial.
Correct Answer: C
Explanation: When mixing insulins, the clear (Regular) insulin should always be drawn
before the cloudy (NPH) insulin to prevent contamination of the short-acting vial. The
nurse should gently roll the NPH vial between the hands rather than shaking it to avoid air
bubbles. Proper sequence involves injecting air into the NPH vial first, then air into the
Regular vial, followed by drawing the Regular and then the NPH.
3. A nurse is caring for a client who is 24 hours post-thyroidectomy. Which assessment finding
requires immediate notification of the healthcare provider?
A. Sore throat when swallowing
B. Pain level of 4 on a scale of 0 to 10
C. Weak, hoarse voice
D. Laryngeal stridor
Correct Answer: D
Explanation: Laryngeal stridor is a harsh, high-pitched sound produced during inspiration
and indicates airway obstruction or laryngeal nerve damage. This is a medical emergency
that requires immediate intervention to maintain airway patency. A sore throat and mild
, pain are expected findings after surgery, while a weak voice is common due to irritation
from the endotracheal tube.
4. A client is diagnosed with Cushing’s Syndrome. The nurse should monitor the client for
which of the following electrolyte imbalances?
A. Hyperkalemia and Hyponatremia
B. Hypercalcemia and Hypophosphatemia
C. Hypocalcemia and Hypermagnesemia
D. Hypokalemia and Hypernatremia
Correct Answer: D
Explanation: Cushing’s Syndrome involves an excess of cortisol, which has
mineralocorticoid effects leading to sodium retention and potassium excretion.
Consequently, clients frequently exhibit hypernatremia and hypokalemia. Management
focuses on monitoring these levels to prevent cardiac complications and fluid overload.
5. Which clinical manifestation should the nurse prioritize when assessing a client for a
potential Addisonian Crisis?
A. Severe hypotension
B. Bradycardia
C. Hyperglycemia
D. Water retention
Surgical Nursing I-A | NCLEX (NGN) Q&A
with Rationale (NU157 Exam 4) | Galen
1. A nurse is assessing a client who has a suspected diagnosis of hypoglycemia. Which clinical
manifestations should the nurse expect to observe? (Select All That Apply)
A. Diaphoresis
B. Palpitations
C. Increased thirst
D. Irritability
E. Confusion
F. Abdominal pain
Correct Answer: A, B, D, E
Explanation: Hypoglycemia triggers the sympathetic nervous system, leading to symptoms
such as diaphoresis, palpitations, and tremors. Neurological symptoms like irritability and
confusion occur as the brain is deprived of necessary glucose. Increased thirst and
abdominal pain are more characteristic of hyperglycemia and diabetic ketoacidosis.
2. A client with type 1 diabetes mellitus is prescribed a combination of NPH and Regular
insulin. Which action by the nurse is correct when preparing these insulins in a single syringe?
A. Draw up the NPH insulin first, followed by the Regular insulin.
,B. Shake the NPH vial vigorously to ensure the suspension is mixed.
C. Draw up the Regular insulin first, followed by the NPH insulin.
D. Inject air into the Regular vial first, then into the NPH vial.
Correct Answer: C
Explanation: When mixing insulins, the clear (Regular) insulin should always be drawn
before the cloudy (NPH) insulin to prevent contamination of the short-acting vial. The
nurse should gently roll the NPH vial between the hands rather than shaking it to avoid air
bubbles. Proper sequence involves injecting air into the NPH vial first, then air into the
Regular vial, followed by drawing the Regular and then the NPH.
3. A nurse is caring for a client who is 24 hours post-thyroidectomy. Which assessment finding
requires immediate notification of the healthcare provider?
A. Sore throat when swallowing
B. Pain level of 4 on a scale of 0 to 10
C. Weak, hoarse voice
D. Laryngeal stridor
Correct Answer: D
Explanation: Laryngeal stridor is a harsh, high-pitched sound produced during inspiration
and indicates airway obstruction or laryngeal nerve damage. This is a medical emergency
that requires immediate intervention to maintain airway patency. A sore throat and mild
, pain are expected findings after surgery, while a weak voice is common due to irritation
from the endotracheal tube.
4. A client is diagnosed with Cushing’s Syndrome. The nurse should monitor the client for
which of the following electrolyte imbalances?
A. Hyperkalemia and Hyponatremia
B. Hypercalcemia and Hypophosphatemia
C. Hypocalcemia and Hypermagnesemia
D. Hypokalemia and Hypernatremia
Correct Answer: D
Explanation: Cushing’s Syndrome involves an excess of cortisol, which has
mineralocorticoid effects leading to sodium retention and potassium excretion.
Consequently, clients frequently exhibit hypernatremia and hypokalemia. Management
focuses on monitoring these levels to prevent cardiac complications and fluid overload.
5. Which clinical manifestation should the nurse prioritize when assessing a client for a
potential Addisonian Crisis?
A. Severe hypotension
B. Bradycardia
C. Hyperglycemia
D. Water retention
