NRSG 201 Exam 4 V3 | NRSG 201 Med Surg 1 |
Actual Q&A with Rationale (NRSG201 Exam 4) | Ivy
Tech
1. A patient is admitted with a blood glucose level of 650 mg/dL, Kussmaul respirations, and a
fruity odor to the breath. Which acid-base imbalance does the nurse expect to find in the
arterial blood gas (ABG) results?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
Correct Answer: B
Explanation: Kussmaul respirations are a compensatory mechanism for metabolic
acidosis, specifically diabetic ketoacidosis (DKA), to blow off carbon dioxide. The fruity
breath odor is caused by the presence of acetone, a ketone body produced during the
breakdown of fats. The patient’s high glucose and symptoms are classic indicators of DKA,
which results in a pH below 7.35 and low bicarbonate levels.
2. A nurse is caring for a patient who underwent a subtotal thyroidectomy 4 hours ago. Which
finding is the most critical for the nurse to report to the healthcare provider immediately?
A. Patient reports pain at the incision site as a 4 on a scale of 0-10
B. Patient reports a feeling of fullness at the back of the throat
,C. Frequent swallowing and a dressing that is saturated with bright red blood
D. Hoarseness when the patient speaks
Correct Answer: C
Explanation: Frequent swallowing after thyroid surgery often indicates hemorrhage or
bleeding in the neck, which can lead to airway compression. A saturated dressing with
bright red blood confirms active bleeding that requires immediate surgical intervention.
While hoarseness is common, it should be monitored, but airway patency and bleeding take
absolute priority in the early postoperative period.
3. A patient with Type 2 Diabetes is prescribed Metformin (Glucophage). Which diagnostic
test should the nurse ensure is reviewed before the patient undergoes a scheduled CT scan
with contrast dye?
A. Hemoglobin A1c
B. Serum creatinine levels
C. Liver function tests (ALT/AST)
D. Complete blood count (CBC)
Correct Answer: B
Explanation: Metformin must be discontinued 48 hours before and after procedures
involving IV contrast dye because both Metformin and contrast are excreted by the
kidneys. If the patient has impaired renal function, the combination significantly increases
, the risk of lactic acidosis. Checking serum creatinine ensures the kidneys are functioning
adequately to process these substances safely.
4. A nurse is assessing a patient with Cushing’s syndrome. Which clinical manifestations
should the nurse expect to observe?
A. Weight loss, hypotension, and hyperpigmentation
B. Thin skin, bradycardia, and cold intolerance
C. Tachycardia, tremors, and exophthalmos
D. Trunkal obesity, moon face, and purple striae on the abdomen
Correct Answer: D
Explanation: Cushing’s syndrome is characterized by an excess of cortisol, leading to a
redistribution of fat to the trunk and face. The presence of purple striae is caused by the
thinning of the skin and loss of collagen due to high corticosteroid levels.
Hyperpigmentation and hypotension are actually signs of Addison’s disease, the opposite
clinical condition.
5. A patient with diabetes insipidus (DI) is receiving desmopressin (DDAVP). Which finding
indicates that the medication is effective?
A. Decreased serum sodium levels
B. Increased urine output
C. Decreased blood pressure
Actual Q&A with Rationale (NRSG201 Exam 4) | Ivy
Tech
1. A patient is admitted with a blood glucose level of 650 mg/dL, Kussmaul respirations, and a
fruity odor to the breath. Which acid-base imbalance does the nurse expect to find in the
arterial blood gas (ABG) results?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
Correct Answer: B
Explanation: Kussmaul respirations are a compensatory mechanism for metabolic
acidosis, specifically diabetic ketoacidosis (DKA), to blow off carbon dioxide. The fruity
breath odor is caused by the presence of acetone, a ketone body produced during the
breakdown of fats. The patient’s high glucose and symptoms are classic indicators of DKA,
which results in a pH below 7.35 and low bicarbonate levels.
2. A nurse is caring for a patient who underwent a subtotal thyroidectomy 4 hours ago. Which
finding is the most critical for the nurse to report to the healthcare provider immediately?
A. Patient reports pain at the incision site as a 4 on a scale of 0-10
B. Patient reports a feeling of fullness at the back of the throat
,C. Frequent swallowing and a dressing that is saturated with bright red blood
D. Hoarseness when the patient speaks
Correct Answer: C
Explanation: Frequent swallowing after thyroid surgery often indicates hemorrhage or
bleeding in the neck, which can lead to airway compression. A saturated dressing with
bright red blood confirms active bleeding that requires immediate surgical intervention.
While hoarseness is common, it should be monitored, but airway patency and bleeding take
absolute priority in the early postoperative period.
3. A patient with Type 2 Diabetes is prescribed Metformin (Glucophage). Which diagnostic
test should the nurse ensure is reviewed before the patient undergoes a scheduled CT scan
with contrast dye?
A. Hemoglobin A1c
B. Serum creatinine levels
C. Liver function tests (ALT/AST)
D. Complete blood count (CBC)
Correct Answer: B
Explanation: Metformin must be discontinued 48 hours before and after procedures
involving IV contrast dye because both Metformin and contrast are excreted by the
kidneys. If the patient has impaired renal function, the combination significantly increases
, the risk of lactic acidosis. Checking serum creatinine ensures the kidneys are functioning
adequately to process these substances safely.
4. A nurse is assessing a patient with Cushing’s syndrome. Which clinical manifestations
should the nurse expect to observe?
A. Weight loss, hypotension, and hyperpigmentation
B. Thin skin, bradycardia, and cold intolerance
C. Tachycardia, tremors, and exophthalmos
D. Trunkal obesity, moon face, and purple striae on the abdomen
Correct Answer: D
Explanation: Cushing’s syndrome is characterized by an excess of cortisol, leading to a
redistribution of fat to the trunk and face. The presence of purple striae is caused by the
thinning of the skin and loss of collagen due to high corticosteroid levels.
Hyperpigmentation and hypotension are actually signs of Addison’s disease, the opposite
clinical condition.
5. A patient with diabetes insipidus (DI) is receiving desmopressin (DDAVP). Which finding
indicates that the medication is effective?
A. Decreased serum sodium levels
B. Increased urine output
C. Decreased blood pressure
