NUR 390 Exam 4 V2 | NUR 390 Nursing Care of the
Adult I | Actual Q&A with Rationale (NUR390 Exam
4) | Concordia
1. A nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). Which
clinical finding should the nurse prioritize?
A. Heart rate of 110 bpm and tall, peaked T waves
B. Urine output of 600 mL/day
C. Weight loss of 2 kg in 24 hours
D. Blood urea nitrogen (BUN) of 25 mg/dL
Correct Answer: A
Explanation: Tall, peaked T waves are a classic sign of hyperkalemia, which is a life-
threatening complication during the oliguric phase of AKI. The nurse must prioritize
cardiac monitoring and potential interventions like calcium gluconate or insulin/dextrose
to prevent cardiac arrest. In the oliguric phase, the kidneys fail to excrete potassium,
leading to rapid serum level increases.
2. The nurse is assessing a patient with Cushing’s syndrome. Which group of clinical
manifestations should the nurse expect to find?
A. Weight loss, hypotension, and bronze skin
B. Tachycardia, exophthalmos, and heat intolerance
,C. Central obesity, buffalo hump, and hypertension
D. Polyuria, polydipsia, and polyphagia
Correct Answer: C
Explanation: Cushing’s syndrome is characterized by an excess of corticosteroids,
particularly glucocorticoids. This leads to fat redistribution resulting in central obesity and
a buffalo hump, along with mineralocorticoid effects like hypertension. Assessment
findings are distinct from Addison’s disease or hyperthyroidism, which present with
weight loss and different metabolic shifts.
3. A patient with Type 1 Diabetes Mellitus presents to the ED with Kussmaul respirations, a
blood glucose of 550 mg/dL, and ketonuria. Which is the nurse’s priority action?
A. Administer 10 units of subcutaneous Glargine insulin
B. Initiate intravenous fluid resuscitation with Normal Saline
C. Obtain an arterial blood gas to check for respiratory alkalosis
D. Administer oral glucose tablets immediately
Correct Answer: B
Explanation: The patient is presenting with signs of Diabetic Ketoacidosis (DKA), and the
immediate priority is fluid resuscitation to restore circulatory volume. Dehydration in DKA
is severe due to osmotic diuresis, and IV fluids must be started before or alongside insulin
therapy. Insulin glargine is a long-acting insulin and is not appropriate for the acute
management of DKA.
, 4. The nurse is providing discharge teaching for a patient with chronic kidney disease (CKD)
who is receiving hemodialysis. Which statement by the patient indicates a need for further
teaching?
A. I need to increase my intake of dairy products to strengthen my bones.
B. I should avoid using salt substitutes because they contain potassium.
C. I will take my phosphate binders immediately after I finish my meal.
D. I will weigh myself daily and report a gain of more than 2 pounds.
Correct Answer: A
Explanation: Patients with CKD must limit dairy products because they are high in
phosphorus, which the kidneys cannot effectively excrete. High phosphorus levels
contribute to renal osteodystrophy and secondary hyperparathyroidism. The other
statements regarding weight monitoring, salt substitutes, and phosphate binder timing are
correct for managing CKD.
5. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which laboratory result should the nurse anticipate?
A. Urine specific gravity 1.002
B. Serum sodium 128 mEq/L
C. Serum osmolality 310 mOsm/kg
D. Hematocrit 55%
Adult I | Actual Q&A with Rationale (NUR390 Exam
4) | Concordia
1. A nurse is caring for a patient in the oliguric phase of acute kidney injury (AKI). Which
clinical finding should the nurse prioritize?
A. Heart rate of 110 bpm and tall, peaked T waves
B. Urine output of 600 mL/day
C. Weight loss of 2 kg in 24 hours
D. Blood urea nitrogen (BUN) of 25 mg/dL
Correct Answer: A
Explanation: Tall, peaked T waves are a classic sign of hyperkalemia, which is a life-
threatening complication during the oliguric phase of AKI. The nurse must prioritize
cardiac monitoring and potential interventions like calcium gluconate or insulin/dextrose
to prevent cardiac arrest. In the oliguric phase, the kidneys fail to excrete potassium,
leading to rapid serum level increases.
2. The nurse is assessing a patient with Cushing’s syndrome. Which group of clinical
manifestations should the nurse expect to find?
A. Weight loss, hypotension, and bronze skin
B. Tachycardia, exophthalmos, and heat intolerance
,C. Central obesity, buffalo hump, and hypertension
D. Polyuria, polydipsia, and polyphagia
Correct Answer: C
Explanation: Cushing’s syndrome is characterized by an excess of corticosteroids,
particularly glucocorticoids. This leads to fat redistribution resulting in central obesity and
a buffalo hump, along with mineralocorticoid effects like hypertension. Assessment
findings are distinct from Addison’s disease or hyperthyroidism, which present with
weight loss and different metabolic shifts.
3. A patient with Type 1 Diabetes Mellitus presents to the ED with Kussmaul respirations, a
blood glucose of 550 mg/dL, and ketonuria. Which is the nurse’s priority action?
A. Administer 10 units of subcutaneous Glargine insulin
B. Initiate intravenous fluid resuscitation with Normal Saline
C. Obtain an arterial blood gas to check for respiratory alkalosis
D. Administer oral glucose tablets immediately
Correct Answer: B
Explanation: The patient is presenting with signs of Diabetic Ketoacidosis (DKA), and the
immediate priority is fluid resuscitation to restore circulatory volume. Dehydration in DKA
is severe due to osmotic diuresis, and IV fluids must be started before or alongside insulin
therapy. Insulin glargine is a long-acting insulin and is not appropriate for the acute
management of DKA.
, 4. The nurse is providing discharge teaching for a patient with chronic kidney disease (CKD)
who is receiving hemodialysis. Which statement by the patient indicates a need for further
teaching?
A. I need to increase my intake of dairy products to strengthen my bones.
B. I should avoid using salt substitutes because they contain potassium.
C. I will take my phosphate binders immediately after I finish my meal.
D. I will weigh myself daily and report a gain of more than 2 pounds.
Correct Answer: A
Explanation: Patients with CKD must limit dairy products because they are high in
phosphorus, which the kidneys cannot effectively excrete. High phosphorus levels
contribute to renal osteodystrophy and secondary hyperparathyroidism. The other
statements regarding weight monitoring, salt substitutes, and phosphate binder timing are
correct for managing CKD.
5. A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
Which laboratory result should the nurse anticipate?
A. Urine specific gravity 1.002
B. Serum sodium 128 mEq/L
C. Serum osmolality 310 mOsm/kg
D. Hematocrit 55%
