NU 186 Exam 4 V1 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 4) | Galen
1. A nurse is caring for a client with an arterial blood gas (ABG) result showing pH 7.31, PaCO2
50 mmHg, and HCO3 24 mEq/L. Which acid-base imbalance does the nurse identify?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Explanation; The client’s pH is below the normal range of 7.35 to 7.45, indicating acidosis.
The PaCO2 is elevated above 45 mmHg, which suggests a respiratory origin for the
imbalance. Since the bicarbonate level is within the normal range, this is identified as
uncompensated respiratory acidosis.
2. A nurse is assessing a client with acute respiratory distress syndrome (ARDS). Which
assessment finding is most characteristic of the early stage of this condition?
A. Severe refractory hypoxemia
B. Rapid onset of dyspnea and tachypnea
C. Productive cough with pink frothy sputum
,D. Visible hyperinflation on chest X-ray
Correct Answer: B
Explanation; In the early phase of ARDS, the client typically presents with rapid, shallow
breathing and a sense of air hunger. Hypoxemia at this stage may respond to oxygen, but as
the condition progresses, it becomes refractory. Recognizing these early signs is critical for
initiating prompt intervention and preventing further lung injury.
3. A client is diagnosed with Cushing’s Syndrome. Which clinical manifestations should the
nurse expect to find? (Select All That Apply)
A. Truncal obesity
B. Thin, fragile skin
C. Hypotension
D. Moon face
E. Hypoglycemia
F. Purple striae on the abdomen
Correct Answer: A,B,D,F
Explanation; Cushing’s syndrome results from an excess of cortisol, which leads to
characteristic physical changes like truncal obesity and a rounded moon face. The excess
cortisol also causes protein wasting, which leads to thin skin and the appearance of purple
,striae. Hypertension and hyperglycemia are also common, rather than hypotension and
hypoglycemia.
4. A nurse is educating a client with Type 1 Diabetes Mellitus about the Somogyi effect.
Which instruction should the nurse include?
A. Increase the evening dose of NPH insulin.
B. Check blood glucose levels at 0300.
C. Avoid eating a bedtime snack.
D. Limit carbohydrate intake during the day.
Correct Answer: B
Explanation; The Somogyi effect involves nighttime hypoglycemia followed by rebound
morning hyperglycemia. Checking the blood glucose at 3:00 AM helps differentiate it from
the Dawn phenomenon, as glucose will be low in the Somogyi effect. Management typically
involves decreasing the nighttime insulin dose or providing a larger bedtime snack.
5. Which electrolyte imbalance should the nurse prioritize monitoring for a client with a new
diagnosis of hypoparathyroidism?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
, Correct Answer: B
Explanation; The parathyroid hormone (PTH) is essential for maintaining serum calcium
levels by acting on the bones, kidneys, and intestines. A deficiency in PTH leads to
decreased calcium absorption and increased excretion, resulting in hypocalcemia. The
nurse must monitor for signs of tetany and neuromuscular irritability, such as Trousseau’s
or Chvostek’s signs.
6. A client with acute kidney injury (AKI) enters the diuresis phase. What is the nurse’s
primary concern during this phase?
A. Dehydration and electrolyte loss
B. Metabolic acidosis
C. Fluid volume excess
D. Sudden increase in BUN
Correct Answer: A
Explanation; During the diuretic phase of AKI, the kidneys begin to recover their ability to
excrete waste but cannot yet concentrate urine effectively. This leads to the excretion of
large volumes of dilute urine, which can cause severe dehydration and depletion of sodium
and potassium. Nurses must monitor intake and output closely and assess for signs of
hypovolemia.
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 4) | Galen
1. A nurse is caring for a client with an arterial blood gas (ABG) result showing pH 7.31, PaCO2
50 mmHg, and HCO3 24 mEq/L. Which acid-base imbalance does the nurse identify?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Explanation; The client’s pH is below the normal range of 7.35 to 7.45, indicating acidosis.
The PaCO2 is elevated above 45 mmHg, which suggests a respiratory origin for the
imbalance. Since the bicarbonate level is within the normal range, this is identified as
uncompensated respiratory acidosis.
2. A nurse is assessing a client with acute respiratory distress syndrome (ARDS). Which
assessment finding is most characteristic of the early stage of this condition?
A. Severe refractory hypoxemia
B. Rapid onset of dyspnea and tachypnea
C. Productive cough with pink frothy sputum
,D. Visible hyperinflation on chest X-ray
Correct Answer: B
Explanation; In the early phase of ARDS, the client typically presents with rapid, shallow
breathing and a sense of air hunger. Hypoxemia at this stage may respond to oxygen, but as
the condition progresses, it becomes refractory. Recognizing these early signs is critical for
initiating prompt intervention and preventing further lung injury.
3. A client is diagnosed with Cushing’s Syndrome. Which clinical manifestations should the
nurse expect to find? (Select All That Apply)
A. Truncal obesity
B. Thin, fragile skin
C. Hypotension
D. Moon face
E. Hypoglycemia
F. Purple striae on the abdomen
Correct Answer: A,B,D,F
Explanation; Cushing’s syndrome results from an excess of cortisol, which leads to
characteristic physical changes like truncal obesity and a rounded moon face. The excess
cortisol also causes protein wasting, which leads to thin skin and the appearance of purple
,striae. Hypertension and hyperglycemia are also common, rather than hypotension and
hypoglycemia.
4. A nurse is educating a client with Type 1 Diabetes Mellitus about the Somogyi effect.
Which instruction should the nurse include?
A. Increase the evening dose of NPH insulin.
B. Check blood glucose levels at 0300.
C. Avoid eating a bedtime snack.
D. Limit carbohydrate intake during the day.
Correct Answer: B
Explanation; The Somogyi effect involves nighttime hypoglycemia followed by rebound
morning hyperglycemia. Checking the blood glucose at 3:00 AM helps differentiate it from
the Dawn phenomenon, as glucose will be low in the Somogyi effect. Management typically
involves decreasing the nighttime insulin dose or providing a larger bedtime snack.
5. Which electrolyte imbalance should the nurse prioritize monitoring for a client with a new
diagnosis of hypoparathyroidism?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
, Correct Answer: B
Explanation; The parathyroid hormone (PTH) is essential for maintaining serum calcium
levels by acting on the bones, kidneys, and intestines. A deficiency in PTH leads to
decreased calcium absorption and increased excretion, resulting in hypocalcemia. The
nurse must monitor for signs of tetany and neuromuscular irritability, such as Trousseau’s
or Chvostek’s signs.
6. A client with acute kidney injury (AKI) enters the diuresis phase. What is the nurse’s
primary concern during this phase?
A. Dehydration and electrolyte loss
B. Metabolic acidosis
C. Fluid volume excess
D. Sudden increase in BUN
Correct Answer: A
Explanation; During the diuretic phase of AKI, the kidneys begin to recover their ability to
excrete waste but cannot yet concentrate urine effectively. This leads to the excretion of
large volumes of dilute urine, which can cause severe dehydration and depletion of sodium
and potassium. Nurses must monitor intake and output closely and assess for signs of
hypovolemia.
