NU 192 Exam 4 V3 | NU 192 Medical-
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 4) | Galen
1. A nurse is caring for a client with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding is the nurse most likely to observe?
A. Urine specific gravity of 1.002
B. Serum osmolality of 310 mOsm/kg
C. Serum sodium of 120 mEq/L
D. Hematocrit of 52%
Correct Answer: C
Explanation: SIADH involves excessive ADH secretion, leading to significant water
retention and dilutional hyponatremia. A serum sodium of 120 mEq/L reflects this
dilutional effect. The nurse should also expect decreased serum osmolality and increased
urine specific gravity due to concentrated urine.
2. A client is receiving internal radiation (brachytherapy) for cervical cancer. Which safety
precautions should the nurse implement? Select all that apply.
A. Assign the client to a private room
B. Wear a lead apron when providing direct care
C. Limit visitor time to 30 minutes per day
,D. Maintain a distance of at least 6 feet from the source
E. Keep all linens in the room until the source is removed
F. Allow pregnant staff to provide care if wearing a dosimeter
Correct Answer: A, B, C, D, E
Explanation: Safety protocols for internal radiation involve time, distance, and shielding to
minimize exposure. A private room prevents exposure to other patients, while lead aprons
and distance protect the healthcare worker. Pregnant women and children should never be
allowed in the room because radiation is teratogenic.
3. A nurse assesses a client undergoing peritoneal dialysis and notes that the outflow is less
than the inflow. Which action should the nurse take first?
A. Notify the healthcare provider immediately
B. Reposition the client to a side-lying position
C. Check the tubing for kinks or clots
D. Irrigate the catheter with heparinized saline
Correct Answer: C
Explanation: Inadequate outflow in peritoneal dialysis is often caused by mechanical
obstructions. The nurse should first check the drainage system for kinks, closed clamps, or
external obstructions. If no kinks are found, repositioning the client is the next appropriate
step to facilitate drainage by gravity.
, 4. A client with cirrhosis is prescribed lactulose. Which finding indicates the medication is
achieving its therapeutic effect?
A. The client’s serum ammonia level is decreasing
B. The client has one soft bowel movement daily
C. The client’s abdominal girth is reducing
D. The client’s alanine aminotransferase (ALT) level is normal
Correct Answer: A
Explanation: Lactulose is administered to clients with hepatic encephalopathy to reduce
serum ammonia levels. It works by trapping ammonia in the gut and promoting its
excretion through frequent bowel movements. The goal is typically 2 to 3 soft stools per
day, accompanied by improved neurological status.
5. A nurse is caring for a client with Diabetes Insipidus (DI). Which assessment finding is
consistent with this diagnosis?
A. High serum osmolality and polyuria
B. Low urine output with high specific gravity
C. Weight gain and edema
D. Blood pressure of 160/94 mmHg
Correct Answer: A
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 4) | Galen
1. A nurse is caring for a client with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding is the nurse most likely to observe?
A. Urine specific gravity of 1.002
B. Serum osmolality of 310 mOsm/kg
C. Serum sodium of 120 mEq/L
D. Hematocrit of 52%
Correct Answer: C
Explanation: SIADH involves excessive ADH secretion, leading to significant water
retention and dilutional hyponatremia. A serum sodium of 120 mEq/L reflects this
dilutional effect. The nurse should also expect decreased serum osmolality and increased
urine specific gravity due to concentrated urine.
2. A client is receiving internal radiation (brachytherapy) for cervical cancer. Which safety
precautions should the nurse implement? Select all that apply.
A. Assign the client to a private room
B. Wear a lead apron when providing direct care
C. Limit visitor time to 30 minutes per day
,D. Maintain a distance of at least 6 feet from the source
E. Keep all linens in the room until the source is removed
F. Allow pregnant staff to provide care if wearing a dosimeter
Correct Answer: A, B, C, D, E
Explanation: Safety protocols for internal radiation involve time, distance, and shielding to
minimize exposure. A private room prevents exposure to other patients, while lead aprons
and distance protect the healthcare worker. Pregnant women and children should never be
allowed in the room because radiation is teratogenic.
3. A nurse assesses a client undergoing peritoneal dialysis and notes that the outflow is less
than the inflow. Which action should the nurse take first?
A. Notify the healthcare provider immediately
B. Reposition the client to a side-lying position
C. Check the tubing for kinks or clots
D. Irrigate the catheter with heparinized saline
Correct Answer: C
Explanation: Inadequate outflow in peritoneal dialysis is often caused by mechanical
obstructions. The nurse should first check the drainage system for kinks, closed clamps, or
external obstructions. If no kinks are found, repositioning the client is the next appropriate
step to facilitate drainage by gravity.
, 4. A client with cirrhosis is prescribed lactulose. Which finding indicates the medication is
achieving its therapeutic effect?
A. The client’s serum ammonia level is decreasing
B. The client has one soft bowel movement daily
C. The client’s abdominal girth is reducing
D. The client’s alanine aminotransferase (ALT) level is normal
Correct Answer: A
Explanation: Lactulose is administered to clients with hepatic encephalopathy to reduce
serum ammonia levels. It works by trapping ammonia in the gut and promoting its
excretion through frequent bowel movements. The goal is typically 2 to 3 soft stools per
day, accompanied by improved neurological status.
5. A nurse is caring for a client with Diabetes Insipidus (DI). Which assessment finding is
consistent with this diagnosis?
A. High serum osmolality and polyuria
B. Low urine output with high specific gravity
C. Weight gain and edema
D. Blood pressure of 160/94 mmHg
Correct Answer: A
