TNT 800.8 IP INTERN PROJECT: THE INSTRUCTIONAL
CYCLE | GRADE 4 MATHEMATICS, TEKS DATA
ANALYSIS, STUDENT GROUPING & INTERVENTION
PLAN | 2026 UPDATE!!!
Part 1: Medical-Surgical Nursing (Questions 1-50)
1. A nurse is caring for a client with a diagnosis of Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). Which of the following findings should the
nurse expect to assess?
A. Increased serum sodium and decreased urine output
B. Decreased serum sodium and decreased urine output
C. Increased serum sodium and increased urine output
D. Decreased serum sodium and increased urine output
Correct Answer: B
Rationale: SIADH is characterized by excessive release of ADH, leading to
water retention. This causes a dilutional hyponatremia (decreased serum
sodium). The kidneys retain water, leading to decreased urine output and
increased urine osmolality.
2. A client is admitted with diabetic ketoacidosis (DKA). Which of the
following intravenous fluids is most appropriate for initial fluid resuscitation?
A. 0.9% Normal Saline
B. 0.45% Normal Saline
,C. D5W
D. D5 ½ Normal Saline
Correct Answer: A
Rationale: In DKA, the client is severely dehydrated and hyperosmolar. 0.9%
Normal Saline (isotonic) is the preferred initial fluid to restore intravascular
volume and improve tissue perfusion. Once the blood glucose drops to around
250 mg/dL, the IV fluid is changed to D5W or D5 ½ NS to prevent
hypoglycemia.
3. A nurse is preparing a client for a paracentesis. Which of the following
actions is most important for the nurse to take?
A. Instruct the client to void immediately before the procedure
B. Position the client in a supine, flat position
C. Administer a stool softener as prescribed
D. Have the client sign an informed consent
Correct Answer: A
Rationale: It is crucial for the client to void immediately before a paracentesis
to decrease the risk of puncturing the bladder. Positioning for a paracentesis
is usually sitting upright or semi-Fowler's, not supine. Informed consent is the
provider's responsibility to obtain, though the nurse can witness it.
4. A client is receiving a blood transfusion and reports new onset of chills,
back pain, and flushing. What is the nurse's priority action?
A. Slow the rate of the transfusion
B. Administer diphenhydramine (Benadryl)
C. Stop the transfusion and start a normal saline infusion
,D. Take a set of vital signs
Correct Answer: C
Rationale: The client's symptoms (chills, back pain, flushing) are classic signs
of an acute hemolytic transfusion reaction. The priority action is to stop the
transfusion immediately to prevent further complications, maintain IV access
with normal saline, and notify the provider.
5. A nurse is caring for a client with a chest tube. Which of the following
findings indicates that the chest tube is functioning correctly?
A. Continuous bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber with respirations
C. Absence of drainage in the collection chamber
D. The client is reporting severe pain
Correct Answer: B
Rationale: Tidaling (fluctuation) in the water seal chamber is a normal finding
and indicates that the chest tube is patent and functioning correctly.
Continuous bubbling in the water seal chamber indicates an air leak. Absence
of drainage is not necessarily an indicator of correct function, and severe pain
would need to be assessed.
6. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88%. The nurse administers oxygen. What is the most
appropriate oxygen delivery method for this client?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 8 L/min
C. Nasal cannula at 2 L/min
, D. Venturi mask at 4 L/min
Correct Answer: D
Rationale: Clients with COPD can have a hypoxic drive. Giving high
concentrations of oxygen can suppress their respiratory drive. A Venturi mask
provides the most precise and controlled oxygen concentration, making it the
safest choice. A nasal cannula at 2 L/min can also be appropriate, but a
Venturi mask is specifically designed for COPD patients.
7. A nurse is assessing a client who is 2 hours post-operative from a total hip
arthroplasty. Which of the following findings is most concerning?
A. Pain rating of 6/10 at the surgical site
B. Urinary output of 100 mL in the last 2 hours
C. The client is sleepy but arousable
D. The client reports sudden onset of shortness of breath
Correct Answer: D
Rationale: Post-operative clients, especially after orthopedic surgery, are at
high risk for venous thromboembolism (VTE). Sudden onset shortness of
breath, chest pain, or hemoptysis are classic signs of a pulmonary embolism
(PE), which is a life-threatening emergency.
8. A client with cirrhosis is exhibiting confusion, asterixis, and a flapping
tremor. Which of the following dietary modifications is most important?
A. Low-sodium diet
B. High-protein diet
C. Low-protein diet
D. High-fat diet
CYCLE | GRADE 4 MATHEMATICS, TEKS DATA
ANALYSIS, STUDENT GROUPING & INTERVENTION
PLAN | 2026 UPDATE!!!
Part 1: Medical-Surgical Nursing (Questions 1-50)
1. A nurse is caring for a client with a diagnosis of Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). Which of the following findings should the
nurse expect to assess?
A. Increased serum sodium and decreased urine output
B. Decreased serum sodium and decreased urine output
C. Increased serum sodium and increased urine output
D. Decreased serum sodium and increased urine output
Correct Answer: B
Rationale: SIADH is characterized by excessive release of ADH, leading to
water retention. This causes a dilutional hyponatremia (decreased serum
sodium). The kidneys retain water, leading to decreased urine output and
increased urine osmolality.
2. A client is admitted with diabetic ketoacidosis (DKA). Which of the
following intravenous fluids is most appropriate for initial fluid resuscitation?
A. 0.9% Normal Saline
B. 0.45% Normal Saline
,C. D5W
D. D5 ½ Normal Saline
Correct Answer: A
Rationale: In DKA, the client is severely dehydrated and hyperosmolar. 0.9%
Normal Saline (isotonic) is the preferred initial fluid to restore intravascular
volume and improve tissue perfusion. Once the blood glucose drops to around
250 mg/dL, the IV fluid is changed to D5W or D5 ½ NS to prevent
hypoglycemia.
3. A nurse is preparing a client for a paracentesis. Which of the following
actions is most important for the nurse to take?
A. Instruct the client to void immediately before the procedure
B. Position the client in a supine, flat position
C. Administer a stool softener as prescribed
D. Have the client sign an informed consent
Correct Answer: A
Rationale: It is crucial for the client to void immediately before a paracentesis
to decrease the risk of puncturing the bladder. Positioning for a paracentesis
is usually sitting upright or semi-Fowler's, not supine. Informed consent is the
provider's responsibility to obtain, though the nurse can witness it.
4. A client is receiving a blood transfusion and reports new onset of chills,
back pain, and flushing. What is the nurse's priority action?
A. Slow the rate of the transfusion
B. Administer diphenhydramine (Benadryl)
C. Stop the transfusion and start a normal saline infusion
,D. Take a set of vital signs
Correct Answer: C
Rationale: The client's symptoms (chills, back pain, flushing) are classic signs
of an acute hemolytic transfusion reaction. The priority action is to stop the
transfusion immediately to prevent further complications, maintain IV access
with normal saline, and notify the provider.
5. A nurse is caring for a client with a chest tube. Which of the following
findings indicates that the chest tube is functioning correctly?
A. Continuous bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber with respirations
C. Absence of drainage in the collection chamber
D. The client is reporting severe pain
Correct Answer: B
Rationale: Tidaling (fluctuation) in the water seal chamber is a normal finding
and indicates that the chest tube is patent and functioning correctly.
Continuous bubbling in the water seal chamber indicates an air leak. Absence
of drainage is not necessarily an indicator of correct function, and severe pain
would need to be assessed.
6. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88%. The nurse administers oxygen. What is the most
appropriate oxygen delivery method for this client?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 8 L/min
C. Nasal cannula at 2 L/min
, D. Venturi mask at 4 L/min
Correct Answer: D
Rationale: Clients with COPD can have a hypoxic drive. Giving high
concentrations of oxygen can suppress their respiratory drive. A Venturi mask
provides the most precise and controlled oxygen concentration, making it the
safest choice. A nasal cannula at 2 L/min can also be appropriate, but a
Venturi mask is specifically designed for COPD patients.
7. A nurse is assessing a client who is 2 hours post-operative from a total hip
arthroplasty. Which of the following findings is most concerning?
A. Pain rating of 6/10 at the surgical site
B. Urinary output of 100 mL in the last 2 hours
C. The client is sleepy but arousable
D. The client reports sudden onset of shortness of breath
Correct Answer: D
Rationale: Post-operative clients, especially after orthopedic surgery, are at
high risk for venous thromboembolism (VTE). Sudden onset shortness of
breath, chest pain, or hemoptysis are classic signs of a pulmonary embolism
(PE), which is a life-threatening emergency.
8. A client with cirrhosis is exhibiting confusion, asterixis, and a flapping
tremor. Which of the following dietary modifications is most important?
A. Low-sodium diet
B. High-protein diet
C. Low-protein diet
D. High-fat diet
