NUR 242 Medical Surgical Nursing Exam 4 Practice |
50 Multiple-Choice Questions And Answers | 2026/2027
Updates
Instructions: Select the best answer for each of the following questions.
1. A patient with type 1 diabetes mellitus is admitted with nausea, vomiting, and
abdominal pain. The patient's blood glucose is 620 mg/dL, arterial pH is 7.20, and
serum bicarbonate is 12 mEq/L. The serum ketone level is positive. Which
intervention should the nurse anticipate initiating first?
A. Administration of oral hypoglycemic agents.
B. Insulin infusion and IV fluid replacement.
C. Administration of sodium bicarbonate IV push.
D. Initiation of continuous enteral feeding.
[Correct Answer:] B
[Rationale:] This patient is presenting with diabetic ketoacidosis (DKA) , characterized
by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.30, bicarbonate <15 mEq/L),
and ketonemia. The priority treatment is IV fluid replacement (to correct dehydration and
dilute glucose) and continuous insulin infusion (to reverse ketosis and lower blood
glucose). Sodium bicarbonate (C) is rarely indicated unless pH is <6.9, as it can cause
paradoxical CSF acidosis. Oral hypoglycemics (A) are ineffective in DKA because the patient
cannot take oral medications and insulin is required.
2. A patient with hyperthyroidism is scheduled for a thyroidectomy. The nurse
understands that which preoperative medication is most critical to prevent thyroid
storm?
A. Propylthiouracil (PTU).
B. Propranolol (Inderal).
C. Levothyroxine (Synthroid).
D. Methimazole (Tapazole).
[Correct Answer:] B
[Rationale:] Propranolol is a beta-blocker used preoperatively for patients with
hyperthyroidism to control sympathetic symptoms (tachycardia, palpitations, anxiety,
tremors) and reduce the risk of thyroid storm during surgery. While PTU (A) and
methimazole (D) are antithyroid medications used to reduce thyroid hormone levels,
,propranolol is specifically given to control cardiovascular manifestations and prevent a
hypermetabolic crisis. Levothyroxine (C) is used for hypothyroidism and would be
contraindicated.
3. A patient is diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). Which assessment finding is consistent with this disorder?
A. Serum sodium of 128 mEq/L and urine specific gravity of 1.030.
B. Serum sodium of 155 mEq/L and urine specific gravity of 1.005.
C. Serum potassium of 5.5 mEq/L and urine output of 4 L/day.
D. Serum calcium of 8.5 mg/dL and serum osmolality of 310 mOsm/kg.
[Correct Answer:] A
[Rationale:] SIADH is characterized by excessive release of antidiuretic hormone (ADH),
leading to water retention, dilutional hyponatremia (low serum sodium), and concentrated
urine (high specific gravity). A serum sodium of 128 mEq/L (normal 135-145) and urine
specific gravity of 1.030 (normal 1.005-1.030, but elevated in SIADH) is consistent with
SIADH. High sodium (B) and low specific gravity would be seen in diabetes insipidus. High
urine output (C) and high osmolality (D) are not features of SIADH.
4. The nurse is caring for a patient with chronic kidney disease (CKD) who is
receiving hemodialysis. Which laboratory finding is most important to report to the
provider before dialysis?
A. Serum potassium of 5.8 mEq/L.
B. Serum phosphorus of 5.0 mg/dL.
C. Hemoglobin of 10.5 g/dL.
D. Serum calcium of 8.0 mg/dL.
[Correct Answer:] A
[Rationale:] A serum potassium of 5.8 mEq/L is hyperkalemia and is a life-threatening
electrolyte imbalance that can cause cardiac arrhythmias. While patients with CKD often
have elevated potassium, a level of 5.8 is significantly elevated and requires immediate
intervention. Dialysis will help correct this, but the provider needs to be notified.
Hyperphosphatemia (B), anemia (C), and hypocalcemia (D) are common findings in CKD
and are not immediately life-threatening, though they require management.
5. A patient with diabetes insipidus (DI) is receiving desmopressin (DDAVP) nasal
spray. Which assessment finding indicates that the treatment is effective?
, A. Urine output decreases to 2 L/day and urine specific gravity increases.
B. Urine output increases to 5 L/day and blood pressure decreases.
C. Serum sodium decreases to 130 mEq/L and serum osmolality decreases.
D. The patient reports increased thirst and dry mucous membranes.
[Correct Answer:] A
[Rationale:] Diabetes insipidus is characterized by excessive urine output (polyuria) and
dilute urine (low specific gravity) due to a lack of ADH. Desmopressin is a synthetic ADH
analog that promotes water reabsorption in the kidneys. Effective treatment results
in decreased urine output (to normal 1-2 L/day) and increased urine specific
gravity (more concentrated urine). Increased urine output (B) indicates treatment failure.
Low sodium (C) suggests overcorrection and water intoxication. Thirst (D) indicates the
treatment is not fully effective.
6. The nurse is assessing a patient who is 24 hours post-total thyroidectomy. The
patient reports tingling around the mouth and in the fingers. The nurse notes a
positive Chvostek's sign. Which complication does the nurse suspect?
A. Thyroid storm.
B. Hypocalcemia.
C. Airway obstruction.
D. Hemorrhage.
[Correct Answer:] B
[Rationale:] Tingling around the mouth (paresthesia), tingling in the fingers, and a positive
Chvostek's sign (facial twitching when tapping the facial nerve) are classic signs
of hypocalcemia. This can occur after thyroidectomy if the parathyroid glands are
accidentally removed or damaged during surgery, leading to decreased parathyroid
hormone (PTH) and subsequent hypocalcemia. Thyroid storm (A) is characterized by
hyperthermia, tachycardia, and hypertension. Airway obstruction (C) would present with
stridor and respiratory distress. Hemorrhage (D) would present with neck swelling and
hematoma.
7. A patient is admitted with acute pyelonephritis. The nurse should expect which
assessment finding?
A. Costovertebral angle tenderness and high fever.
B. Suprapubic pain and urinary frequency.
C. Flank pain and gross hematuria.
D. Dysuria and urinary urgency.
50 Multiple-Choice Questions And Answers | 2026/2027
Updates
Instructions: Select the best answer for each of the following questions.
1. A patient with type 1 diabetes mellitus is admitted with nausea, vomiting, and
abdominal pain. The patient's blood glucose is 620 mg/dL, arterial pH is 7.20, and
serum bicarbonate is 12 mEq/L. The serum ketone level is positive. Which
intervention should the nurse anticipate initiating first?
A. Administration of oral hypoglycemic agents.
B. Insulin infusion and IV fluid replacement.
C. Administration of sodium bicarbonate IV push.
D. Initiation of continuous enteral feeding.
[Correct Answer:] B
[Rationale:] This patient is presenting with diabetic ketoacidosis (DKA) , characterized
by hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.30, bicarbonate <15 mEq/L),
and ketonemia. The priority treatment is IV fluid replacement (to correct dehydration and
dilute glucose) and continuous insulin infusion (to reverse ketosis and lower blood
glucose). Sodium bicarbonate (C) is rarely indicated unless pH is <6.9, as it can cause
paradoxical CSF acidosis. Oral hypoglycemics (A) are ineffective in DKA because the patient
cannot take oral medications and insulin is required.
2. A patient with hyperthyroidism is scheduled for a thyroidectomy. The nurse
understands that which preoperative medication is most critical to prevent thyroid
storm?
A. Propylthiouracil (PTU).
B. Propranolol (Inderal).
C. Levothyroxine (Synthroid).
D. Methimazole (Tapazole).
[Correct Answer:] B
[Rationale:] Propranolol is a beta-blocker used preoperatively for patients with
hyperthyroidism to control sympathetic symptoms (tachycardia, palpitations, anxiety,
tremors) and reduce the risk of thyroid storm during surgery. While PTU (A) and
methimazole (D) are antithyroid medications used to reduce thyroid hormone levels,
,propranolol is specifically given to control cardiovascular manifestations and prevent a
hypermetabolic crisis. Levothyroxine (C) is used for hypothyroidism and would be
contraindicated.
3. A patient is diagnosed with syndrome of inappropriate antidiuretic hormone
(SIADH). Which assessment finding is consistent with this disorder?
A. Serum sodium of 128 mEq/L and urine specific gravity of 1.030.
B. Serum sodium of 155 mEq/L and urine specific gravity of 1.005.
C. Serum potassium of 5.5 mEq/L and urine output of 4 L/day.
D. Serum calcium of 8.5 mg/dL and serum osmolality of 310 mOsm/kg.
[Correct Answer:] A
[Rationale:] SIADH is characterized by excessive release of antidiuretic hormone (ADH),
leading to water retention, dilutional hyponatremia (low serum sodium), and concentrated
urine (high specific gravity). A serum sodium of 128 mEq/L (normal 135-145) and urine
specific gravity of 1.030 (normal 1.005-1.030, but elevated in SIADH) is consistent with
SIADH. High sodium (B) and low specific gravity would be seen in diabetes insipidus. High
urine output (C) and high osmolality (D) are not features of SIADH.
4. The nurse is caring for a patient with chronic kidney disease (CKD) who is
receiving hemodialysis. Which laboratory finding is most important to report to the
provider before dialysis?
A. Serum potassium of 5.8 mEq/L.
B. Serum phosphorus of 5.0 mg/dL.
C. Hemoglobin of 10.5 g/dL.
D. Serum calcium of 8.0 mg/dL.
[Correct Answer:] A
[Rationale:] A serum potassium of 5.8 mEq/L is hyperkalemia and is a life-threatening
electrolyte imbalance that can cause cardiac arrhythmias. While patients with CKD often
have elevated potassium, a level of 5.8 is significantly elevated and requires immediate
intervention. Dialysis will help correct this, but the provider needs to be notified.
Hyperphosphatemia (B), anemia (C), and hypocalcemia (D) are common findings in CKD
and are not immediately life-threatening, though they require management.
5. A patient with diabetes insipidus (DI) is receiving desmopressin (DDAVP) nasal
spray. Which assessment finding indicates that the treatment is effective?
, A. Urine output decreases to 2 L/day and urine specific gravity increases.
B. Urine output increases to 5 L/day and blood pressure decreases.
C. Serum sodium decreases to 130 mEq/L and serum osmolality decreases.
D. The patient reports increased thirst and dry mucous membranes.
[Correct Answer:] A
[Rationale:] Diabetes insipidus is characterized by excessive urine output (polyuria) and
dilute urine (low specific gravity) due to a lack of ADH. Desmopressin is a synthetic ADH
analog that promotes water reabsorption in the kidneys. Effective treatment results
in decreased urine output (to normal 1-2 L/day) and increased urine specific
gravity (more concentrated urine). Increased urine output (B) indicates treatment failure.
Low sodium (C) suggests overcorrection and water intoxication. Thirst (D) indicates the
treatment is not fully effective.
6. The nurse is assessing a patient who is 24 hours post-total thyroidectomy. The
patient reports tingling around the mouth and in the fingers. The nurse notes a
positive Chvostek's sign. Which complication does the nurse suspect?
A. Thyroid storm.
B. Hypocalcemia.
C. Airway obstruction.
D. Hemorrhage.
[Correct Answer:] B
[Rationale:] Tingling around the mouth (paresthesia), tingling in the fingers, and a positive
Chvostek's sign (facial twitching when tapping the facial nerve) are classic signs
of hypocalcemia. This can occur after thyroidectomy if the parathyroid glands are
accidentally removed or damaged during surgery, leading to decreased parathyroid
hormone (PTH) and subsequent hypocalcemia. Thyroid storm (A) is characterized by
hyperthermia, tachycardia, and hypertension. Airway obstruction (C) would present with
stridor and respiratory distress. Hemorrhage (D) would present with neck swelling and
hematoma.
7. A patient is admitted with acute pyelonephritis. The nurse should expect which
assessment finding?
A. Costovertebral angle tenderness and high fever.
B. Suprapubic pain and urinary frequency.
C. Flank pain and gross hematuria.
D. Dysuria and urinary urgency.
