NU 192 Exam 1 V3 | NU 192 Medical-
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 1) | Galen
1. A nurse is caring for a client with a suspected diagnosis of hypothyroidism. Which clinical
manifestations should the nurse expect to observe? Select all that apply.
A. Bradycardia
B. Heat intolerance
C. Weight gain
D. Lethargy
E. Exophthalmos
F. Constipation
Correct Answer: A, C, D, F
Explanation: Hypothyroidism is characterized by a slowing of the body’s metabolic
processes due to a deficiency in thyroid hormone. Clinical manifestations include
bradycardia, weight gain despite poor appetite, lethargy or fatigue, and constipation
resulting from decreased gastrointestinal motility. Heat intolerance and exophthalmos are
classic signs of hyperthyroidism, not hypothyroidism.
,2. A client is admitted to the emergency department with Diabetic Ketoacidosis (DKA). Which
of the following provider orders should the nurse prioritize first?
A. Administer 0.9% Normal Saline at 1000 mL/hr
B. Initiate a continuous regular insulin infusion at 0.1 units/kg/hr
C. Obtain an arterial blood gas (ABG) and basic metabolic panel
D. Administer Potassium Chloride 20 mEq via IV piggyback
Correct Answer: A
Explanation: The initial priority in treating DKA is fluid resuscitation to address
dehydration and restore circulatory volume. Once volume is being restored, insulin therapy
is started to shift the body from a catabolic to an anabolic state. Electrolyte replacement
and diagnostic labs are critical but secondary to correcting the immediate hypovolemia.
3. A nurse is evaluating a client with Chronic Kidney Disease (CKD) for signs of hyperkalemia.
Which ECG change is most characteristic of an elevated potassium level?
A. Prominent U waves
B. Tall, peaked T waves
C. ST-segment depression
D. Shortened PR interval
Correct Answer: B
,Explanation: Hyperkalemia significantly affects the electrical conduction of the heart, with
tall, peaked T waves being the earliest and most characteristic ECG change. As potassium
levels continue to rise, the PR interval may lengthen and the QRS complex will eventually
widen. Prominent U waves are typically associated with hypokalemia, not hyperkalemia.
4. The nurse is providing discharge instructions to a client who underwent a thyroidectomy.
Which statement by the client indicates a need for further teaching?
A. I will need to take thyroid hormone replacement for the rest of my life.
B. I will practice neck range-of-motion exercises every hour while awake.
C. I should notify my doctor if I feel numbness or tingling in my fingers.
D. I should keep a tracheostomy tray at my bedside just in case.
Correct Answer: B
Explanation: Following a thyroidectomy, clients should avoid hyperextension or excessive
movement of the neck to prevent strain on the incision site and internal sutures. Numbness
or tingling may indicate hypocalcemia, which is a potential complication due to accidental
parathyroid damage. Lifelong thyroid hormone replacement is necessary if the entire gland
was removed.
5. A client with cirrhosis and esophageal varices is at risk for hemorrhage. Which of the
following nursing interventions are appropriate for this client? Select all that apply.
A. Avoid straining during bowel movements
B. Monitor for hematemesis and melena
, C. Maintain a high-protein, high-sodium diet
D. Instruct the client to avoid aspirin and NSAIDs
E. Monitor Ammonia levels and mental status
F. Encourage the use of a hard-bristled toothbrush
Correct Answer: A, B, D, E
Explanation: Clients with esophageal varices are at high risk for catastrophic bleeding;
therefore, avoiding factors that increase pressure (like straining) or irritate the mucosa
(like NSAIDs) is vital. Ammonia monitoring is necessary because GI bleeding increases the
protein load in the gut, potentially triggering hepatic encephalopathy. A soft-bristled
toothbrush should be used to prevent bleeding from the gums in a client with
compromised clotting factors.
6. A client is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which
laboratory finding is consistent with this diagnosis?
A. Urine specific gravity of 1.002
B. Serum osmolality of 310 mOsm/kg
C. Serum sodium of 128 mEq/L
D. Hematocrit of 55%
Correct Answer: C
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 1) | Galen
1. A nurse is caring for a client with a suspected diagnosis of hypothyroidism. Which clinical
manifestations should the nurse expect to observe? Select all that apply.
A. Bradycardia
B. Heat intolerance
C. Weight gain
D. Lethargy
E. Exophthalmos
F. Constipation
Correct Answer: A, C, D, F
Explanation: Hypothyroidism is characterized by a slowing of the body’s metabolic
processes due to a deficiency in thyroid hormone. Clinical manifestations include
bradycardia, weight gain despite poor appetite, lethargy or fatigue, and constipation
resulting from decreased gastrointestinal motility. Heat intolerance and exophthalmos are
classic signs of hyperthyroidism, not hypothyroidism.
,2. A client is admitted to the emergency department with Diabetic Ketoacidosis (DKA). Which
of the following provider orders should the nurse prioritize first?
A. Administer 0.9% Normal Saline at 1000 mL/hr
B. Initiate a continuous regular insulin infusion at 0.1 units/kg/hr
C. Obtain an arterial blood gas (ABG) and basic metabolic panel
D. Administer Potassium Chloride 20 mEq via IV piggyback
Correct Answer: A
Explanation: The initial priority in treating DKA is fluid resuscitation to address
dehydration and restore circulatory volume. Once volume is being restored, insulin therapy
is started to shift the body from a catabolic to an anabolic state. Electrolyte replacement
and diagnostic labs are critical but secondary to correcting the immediate hypovolemia.
3. A nurse is evaluating a client with Chronic Kidney Disease (CKD) for signs of hyperkalemia.
Which ECG change is most characteristic of an elevated potassium level?
A. Prominent U waves
B. Tall, peaked T waves
C. ST-segment depression
D. Shortened PR interval
Correct Answer: B
,Explanation: Hyperkalemia significantly affects the electrical conduction of the heart, with
tall, peaked T waves being the earliest and most characteristic ECG change. As potassium
levels continue to rise, the PR interval may lengthen and the QRS complex will eventually
widen. Prominent U waves are typically associated with hypokalemia, not hyperkalemia.
4. The nurse is providing discharge instructions to a client who underwent a thyroidectomy.
Which statement by the client indicates a need for further teaching?
A. I will need to take thyroid hormone replacement for the rest of my life.
B. I will practice neck range-of-motion exercises every hour while awake.
C. I should notify my doctor if I feel numbness or tingling in my fingers.
D. I should keep a tracheostomy tray at my bedside just in case.
Correct Answer: B
Explanation: Following a thyroidectomy, clients should avoid hyperextension or excessive
movement of the neck to prevent strain on the incision site and internal sutures. Numbness
or tingling may indicate hypocalcemia, which is a potential complication due to accidental
parathyroid damage. Lifelong thyroid hormone replacement is necessary if the entire gland
was removed.
5. A client with cirrhosis and esophageal varices is at risk for hemorrhage. Which of the
following nursing interventions are appropriate for this client? Select all that apply.
A. Avoid straining during bowel movements
B. Monitor for hematemesis and melena
, C. Maintain a high-protein, high-sodium diet
D. Instruct the client to avoid aspirin and NSAIDs
E. Monitor Ammonia levels and mental status
F. Encourage the use of a hard-bristled toothbrush
Correct Answer: A, B, D, E
Explanation: Clients with esophageal varices are at high risk for catastrophic bleeding;
therefore, avoiding factors that increase pressure (like straining) or irritate the mucosa
(like NSAIDs) is vital. Ammonia monitoring is necessary because GI bleeding increases the
protein load in the gut, potentially triggering hepatic encephalopathy. A soft-bristled
toothbrush should be used to prevent bleeding from the gums in a client with
compromised clotting factors.
6. A client is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which
laboratory finding is consistent with this diagnosis?
A. Urine specific gravity of 1.002
B. Serum osmolality of 310 mOsm/kg
C. Serum sodium of 128 mEq/L
D. Hematocrit of 55%
Correct Answer: C
