NURS 120 MEDICAL-SURGICAL
NURSING EXAM 4 STUDY GUIDE (2026
UPDATE) WCU
1. A nurse is assessing a patient with Diabetes Insipidus (DI). Which clinical manifestation
should the nurse expect to find?
A. Serum sodium of 130 mEq/L
B. Weight gain and peripheral edema
C. Urine specific gravity of 1.030
D. Excessive thirst and urine output of 500 mL/hour
Answer: D
Conceptual Explanation: DI is characterized by a deficiency of ADH, leading to massive
polyuria and polydipsia. Urine output is high and dilute, while sodium is usually elevated
due to dehydration.
2. A patient is diagnosed with SIADH. Which physician order should the nurse clarify?
A. Infusion of 0.45% Sodium Chloride at 100 mL/hour
B. Fluid restriction of 800 mL/24 hours
C. Administration of Tolvaptan
,D. Daily weights and strict I&O
Answer: A
Conceptual Explanation: SIADH involves excessive ADH, causing water retention and
dilutional hyponatremia. Giving hypotonic solutions like 0.45% NaCl would worsen the
hyponatremia; hypertonic or isotonic solutions are preferred if fluids are given.
3. A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). Which acid-base imbalance is
most consistent with this condition?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: B
Conceptual Explanation: DKA results in the accumulation of ketones, which are acidic,
leading to a drop in bicarbonate and pH, resulting in metabolic acidosis.
4. Which assessment finding is most characteristic of a patient with Myxedema Coma?
A. Tachycardia and heat intolerance
B. Hypothermia and decreased mental status
C. Exophthalmos and goiter
D. Hypertension and diaphoresis
, Answer: B
Conceptual Explanation: Myxedema coma is a severe form of hypothyroidism
characterized by extreme lethargy, hypothermia, bradycardia, and hypotension.
5. A patient with Grave’s disease is scheduled for a thyroidectomy. Which medication does
the nurse anticipate administering preoperatively to reduce the vascularity of the gland?
A. Levothyroxine
B. Lugol’s solution (Iodine)
C. Propylthiouracil (PTU)
D. Atenolol
Answer: B
Conceptual Explanation: Iodine preparations like Lugol’s solution are given
preoperatively to reduce the size and vascularity of the thyroid gland, decreasing the risk of
hemorrhage.
6. A nurse is evaluating a patient with Cushing’s syndrome. Which physical assessment
finding supports this diagnosis?
A. Bronze skin pigmentation
B. Truncal obesity and thin extremities
C. Hyperkalemia and weight loss
D. Low blood pressure and tachycardia
NURSING EXAM 4 STUDY GUIDE (2026
UPDATE) WCU
1. A nurse is assessing a patient with Diabetes Insipidus (DI). Which clinical manifestation
should the nurse expect to find?
A. Serum sodium of 130 mEq/L
B. Weight gain and peripheral edema
C. Urine specific gravity of 1.030
D. Excessive thirst and urine output of 500 mL/hour
Answer: D
Conceptual Explanation: DI is characterized by a deficiency of ADH, leading to massive
polyuria and polydipsia. Urine output is high and dilute, while sodium is usually elevated
due to dehydration.
2. A patient is diagnosed with SIADH. Which physician order should the nurse clarify?
A. Infusion of 0.45% Sodium Chloride at 100 mL/hour
B. Fluid restriction of 800 mL/24 hours
C. Administration of Tolvaptan
,D. Daily weights and strict I&O
Answer: A
Conceptual Explanation: SIADH involves excessive ADH, causing water retention and
dilutional hyponatremia. Giving hypotonic solutions like 0.45% NaCl would worsen the
hyponatremia; hypertonic or isotonic solutions are preferred if fluids are given.
3. A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). Which acid-base imbalance is
most consistent with this condition?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: B
Conceptual Explanation: DKA results in the accumulation of ketones, which are acidic,
leading to a drop in bicarbonate and pH, resulting in metabolic acidosis.
4. Which assessment finding is most characteristic of a patient with Myxedema Coma?
A. Tachycardia and heat intolerance
B. Hypothermia and decreased mental status
C. Exophthalmos and goiter
D. Hypertension and diaphoresis
, Answer: B
Conceptual Explanation: Myxedema coma is a severe form of hypothyroidism
characterized by extreme lethargy, hypothermia, bradycardia, and hypotension.
5. A patient with Grave’s disease is scheduled for a thyroidectomy. Which medication does
the nurse anticipate administering preoperatively to reduce the vascularity of the gland?
A. Levothyroxine
B. Lugol’s solution (Iodine)
C. Propylthiouracil (PTU)
D. Atenolol
Answer: B
Conceptual Explanation: Iodine preparations like Lugol’s solution are given
preoperatively to reduce the size and vascularity of the thyroid gland, decreasing the risk of
hemorrhage.
6. A nurse is evaluating a patient with Cushing’s syndrome. Which physical assessment
finding supports this diagnosis?
A. Bronze skin pigmentation
B. Truncal obesity and thin extremities
C. Hyperkalemia and weight loss
D. Low blood pressure and tachycardia
