NUR 390 Exam 4 V3 | 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 with Chronic Kidney Disease (CKD) whose serum potassium is
6.5 mEq/L. Which action should the nurse take first?
A. Administer sodium polystyrene sulfonate orally.
B. Place the patient on a cardiac monitor.
C. Prepare the patient for emergency hemodialysis.
D. Review the patient’s dietary intake for the last 24 hours.
Correct Answer: B
Explanation: Hyperkalemia is a life-threatening electrolyte imbalance that can lead to fatal
cardiac dysrhythmias. Placing the patient on a cardiac monitor is the priority to detect
changes like peaked T-waves or a widened QRS complex immediately. Other interventions
like administering Kayexalate or dialysis are appropriate but follow initial stabilization and
monitoring.
2. The nurse is evaluating a patient with Type 1 Diabetes Mellitus who is experiencing the
Somogyi effect. Which intervention is most appropriate?
A. Increase the evening dose of intermediate-acting insulin.
B. Decrease the evening dose of intermediate-acting insulin.
,C. Administer a fast-acting insulin bolus at 3:00 AM.
D. Advise the patient to skip the bedtime snack.
Correct Answer: B
Explanation: The Somogyi effect is characterized by hypoglycemia during the night
followed by rebound hyperglycemia in the morning. To manage this, the evening insulin
dose should be decreased or a bedtime snack should be added to prevent the nocturnal dip.
Increasing the dose would exacerbate the underlying hypoglycemia, leading to a more
severe rebound.
3. A patient diagnosed with Cushing’s syndrome is admitted to the medical unit. Which
clinical manifestations should the nurse expect to observe? (Select All That Apply)
A. Trunkal obesity and ‘buffalo hump’
B. Hyperpigmentation of the skin
C. Purple striae on the abdomen
D. Hypotension and bradycardia
E. Thinning of the extremities
F. Hirsutism
Correct Answer: ACEF
Explanation: Cushing’s syndrome results from an excess of corticosteroids, specifically
glucocorticoids. Common signs include trunkal obesity, buffalo hump, purple striae, and
, thin extremities due to protein wasting. Hirsutism is also common due to excess androgens,
whereas hyperpigmentation and hypotension are typically associated with Addison’s
disease.
4. A patient with hyperthyroidism is being treated for a thyroid storm. Which medication
should the nurse anticipate administering to block the peripheral conversion of T4 to T3?
A. Levothyroxine
B. Propylthiouracil (PTU)
C. Methimazole
D. Iodine (Lugol’s solution)
Correct Answer: B
Explanation: Propylthiouracil (PTU) is preferred in thyroid storm because it not only
inhibits the synthesis of thyroid hormones but also blocks the peripheral conversion of T4
to T3. T3 is the more physiologically active form of the hormone, so blocking this
conversion helps reduce symptoms more quickly. Methimazole blocks synthesis but does
not have the peripheral effect.
5. Which assessment finding in a patient with acute pancreatitis should the nurse report to
the provider immediately?
A. Epigastric pain radiating to the back
B. Nausea and vomiting
C. Elevated serum amylase levels
Adult I | Actual Q&A with Rationale (NUR390 Exam
4) | Concordia
1. A nurse is caring for a patient with Chronic Kidney Disease (CKD) whose serum potassium is
6.5 mEq/L. Which action should the nurse take first?
A. Administer sodium polystyrene sulfonate orally.
B. Place the patient on a cardiac monitor.
C. Prepare the patient for emergency hemodialysis.
D. Review the patient’s dietary intake for the last 24 hours.
Correct Answer: B
Explanation: Hyperkalemia is a life-threatening electrolyte imbalance that can lead to fatal
cardiac dysrhythmias. Placing the patient on a cardiac monitor is the priority to detect
changes like peaked T-waves or a widened QRS complex immediately. Other interventions
like administering Kayexalate or dialysis are appropriate but follow initial stabilization and
monitoring.
2. The nurse is evaluating a patient with Type 1 Diabetes Mellitus who is experiencing the
Somogyi effect. Which intervention is most appropriate?
A. Increase the evening dose of intermediate-acting insulin.
B. Decrease the evening dose of intermediate-acting insulin.
,C. Administer a fast-acting insulin bolus at 3:00 AM.
D. Advise the patient to skip the bedtime snack.
Correct Answer: B
Explanation: The Somogyi effect is characterized by hypoglycemia during the night
followed by rebound hyperglycemia in the morning. To manage this, the evening insulin
dose should be decreased or a bedtime snack should be added to prevent the nocturnal dip.
Increasing the dose would exacerbate the underlying hypoglycemia, leading to a more
severe rebound.
3. A patient diagnosed with Cushing’s syndrome is admitted to the medical unit. Which
clinical manifestations should the nurse expect to observe? (Select All That Apply)
A. Trunkal obesity and ‘buffalo hump’
B. Hyperpigmentation of the skin
C. Purple striae on the abdomen
D. Hypotension and bradycardia
E. Thinning of the extremities
F. Hirsutism
Correct Answer: ACEF
Explanation: Cushing’s syndrome results from an excess of corticosteroids, specifically
glucocorticoids. Common signs include trunkal obesity, buffalo hump, purple striae, and
, thin extremities due to protein wasting. Hirsutism is also common due to excess androgens,
whereas hyperpigmentation and hypotension are typically associated with Addison’s
disease.
4. A patient with hyperthyroidism is being treated for a thyroid storm. Which medication
should the nurse anticipate administering to block the peripheral conversion of T4 to T3?
A. Levothyroxine
B. Propylthiouracil (PTU)
C. Methimazole
D. Iodine (Lugol’s solution)
Correct Answer: B
Explanation: Propylthiouracil (PTU) is preferred in thyroid storm because it not only
inhibits the synthesis of thyroid hormones but also blocks the peripheral conversion of T4
to T3. T3 is the more physiologically active form of the hormone, so blocking this
conversion helps reduce symptoms more quickly. Methimazole blocks synthesis but does
not have the peripheral effect.
5. Which assessment finding in a patient with acute pancreatitis should the nurse report to
the provider immediately?
A. Epigastric pain radiating to the back
B. Nausea and vomiting
C. Elevated serum amylase levels
