NU 186 Exam 3 V1 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 3) | Galen
1. A nurse is assessing a client with suspected Addison’s disease. Which of the following
clinical manifestations should the nurse expect to observe? Select all that apply.
A. Hyperpigmentation of the skin
B. Hyperglycemia
C. Hyperkalemia
D. Hyponatremia
E. Weight gain
F. Postural hypotension
Correct Answer: A,C,D,F
Explanation; Addison’s disease is characterized by the hyposecretion of adrenal cortex
hormones, specifically mineralocorticoids and glucocorticoids. The lack of aldosterone
leads to sodium loss (hyponatremia) and potassium retention (hyperkalemia), often
causing hypotension. Hyperpigmentation occurs due to increased ACTH levels, while
hypoglycemia and weight loss are typical findings rather than weight gain or
hyperglycemia.
,2. A client is admitted to the emergency department with a diagnosis of Diabetic Ketoacidosis
(DKA). Which of the following laboratory results should the nurse anticipate?
A. Serum glucose 180 mg/dL and pH 7.35
B. Serum glucose 110 mg/dL and pH 7.10
C. Serum glucose 600 mg/dL and pH 7.45
D. Serum glucose 350 mg/dL and pH 7.20
Correct Answer: D
Explanation; Diabetic Ketoacidosis is defined by hyperglycemia (usually >250 mg/dL),
metabolic acidosis (pH < 7.30), and the presence of ketones. Option B correctly identifies
both the elevated blood sugar and the acidic state. Option C might suggest Hyperosmolar
Hyperglycemic Syndrome (HHS) because the pH is normal/alkaline.
3. A nurse is caring for a client who is 24 hours postoperative following a subtotal
thyroidectomy. Which assessment finding is the priority for the nurse to report to the
healthcare provider?
A. Hoarseness when speaking
B. Laryngeal stridor
C. Sore throat when swallowing
D. Pain level of 4 on a scale of 0 to 10
Correct Answer: B
, Explanation; Laryngeal stridor is an emergency finding indicating airway obstruction,
often due to edema or hypocalcemic tetany following thyroid surgery. While hoarseness is
common, stridor represents a life-threatening compromise to the respiratory system. The
nurse must prioritize airway maintenance and notify the provider immediately.
4. A client with type 2 diabetes mellitus is prescribed metformin. Which education should the
nurse provide regarding this medication? Select all that apply.
A. Take the medication with food to reduce GI upset.
B. Notify the provider if scheduled for a procedure involving IV contrast dye.
C. Check for ketones in urine if blood glucose is over 200 mg/dL.
D. Monitor for signs of lactic acidosis.
E. Metformin works by stimulating the pancreas to release more insulin.
Correct Answer: A,B,D
Explanation; Metformin should be taken with meals to minimize gastrointestinal side
effects like diarrhea or nausea. It must be held before and for 48 hours after IV contrast to
prevent kidney injury and lactic acidosis. Unlike sulfonylureas, metformin works by
decreasing hepatic glucose production rather than stimulating insulin release.
5. The nurse is monitoring a client receiving a blood transfusion. Ten minutes after the
infusion starts, the client reports lumbar pain and chills. Which action should the nurse take
first?
A. Stop the transfusion and disconnect the tubing at the hub.
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 3) | Galen
1. A nurse is assessing a client with suspected Addison’s disease. Which of the following
clinical manifestations should the nurse expect to observe? Select all that apply.
A. Hyperpigmentation of the skin
B. Hyperglycemia
C. Hyperkalemia
D. Hyponatremia
E. Weight gain
F. Postural hypotension
Correct Answer: A,C,D,F
Explanation; Addison’s disease is characterized by the hyposecretion of adrenal cortex
hormones, specifically mineralocorticoids and glucocorticoids. The lack of aldosterone
leads to sodium loss (hyponatremia) and potassium retention (hyperkalemia), often
causing hypotension. Hyperpigmentation occurs due to increased ACTH levels, while
hypoglycemia and weight loss are typical findings rather than weight gain or
hyperglycemia.
,2. A client is admitted to the emergency department with a diagnosis of Diabetic Ketoacidosis
(DKA). Which of the following laboratory results should the nurse anticipate?
A. Serum glucose 180 mg/dL and pH 7.35
B. Serum glucose 110 mg/dL and pH 7.10
C. Serum glucose 600 mg/dL and pH 7.45
D. Serum glucose 350 mg/dL and pH 7.20
Correct Answer: D
Explanation; Diabetic Ketoacidosis is defined by hyperglycemia (usually >250 mg/dL),
metabolic acidosis (pH < 7.30), and the presence of ketones. Option B correctly identifies
both the elevated blood sugar and the acidic state. Option C might suggest Hyperosmolar
Hyperglycemic Syndrome (HHS) because the pH is normal/alkaline.
3. A nurse is caring for a client who is 24 hours postoperative following a subtotal
thyroidectomy. Which assessment finding is the priority for the nurse to report to the
healthcare provider?
A. Hoarseness when speaking
B. Laryngeal stridor
C. Sore throat when swallowing
D. Pain level of 4 on a scale of 0 to 10
Correct Answer: B
, Explanation; Laryngeal stridor is an emergency finding indicating airway obstruction,
often due to edema or hypocalcemic tetany following thyroid surgery. While hoarseness is
common, stridor represents a life-threatening compromise to the respiratory system. The
nurse must prioritize airway maintenance and notify the provider immediately.
4. A client with type 2 diabetes mellitus is prescribed metformin. Which education should the
nurse provide regarding this medication? Select all that apply.
A. Take the medication with food to reduce GI upset.
B. Notify the provider if scheduled for a procedure involving IV contrast dye.
C. Check for ketones in urine if blood glucose is over 200 mg/dL.
D. Monitor for signs of lactic acidosis.
E. Metformin works by stimulating the pancreas to release more insulin.
Correct Answer: A,B,D
Explanation; Metformin should be taken with meals to minimize gastrointestinal side
effects like diarrhea or nausea. It must be held before and for 48 hours after IV contrast to
prevent kidney injury and lactic acidosis. Unlike sulfonylureas, metformin works by
decreasing hepatic glucose production rather than stimulating insulin release.
5. The nurse is monitoring a client receiving a blood transfusion. Ten minutes after the
infusion starts, the client reports lumbar pain and chills. Which action should the nurse take
first?
A. Stop the transfusion and disconnect the tubing at the hub.
