Galen NUR 265 Medical-Surgical Nursing (TESTED
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Exam 2
1. Twelve hours after pituitary surgery, a patient has urine output 350 mL/hr for 3 hours, intense thirst, urine specific
gravity 1.002, and rising serum sodium. Which complication is most likely?
A. Diabetes insipidus.
B. Adrenal crisis caused by excess aldosterone.
C. Myxedema coma.
D. SIADH.
Correct Answer: A. Diabetes insipidus.
Rationale: Abrupt high-volume dilute urine with hypernatremia after pituitary surgery suggests deficient ADH activity and central DI. Fluid
balance, sodium, and need for desmopressin require prompt attention.
2. Which statement by a patient taking chronic glucocorticoid replacement for adrenal insufficiency indicates correct
understanding?
A. "I should stop steroids whenever I have a fever."
B. "I do not need a medical alert identification."
C. "I may need a higher stress dose during serious illness or surgery and should never stop the medication abruptly."
D. "Vomiting for a day is harmless because the drug remains stored in the body."
Correct Answer: C. "I may need a higher stress dose during serious illness or surgery and should never stop the medication
abruptly."
Rationale: Patients with adrenal insufficiency need uninterrupted glucocorticoid replacement and often increased dosing during physiologic
stress. Inability to retain oral medication can precipitate adrenal crisis and requires urgent care.
3. Which problem is commonly associated with primary hyperparathyroidism?
A. Severe hyponatremia from excess ADH as the defining feature.
B. Profound hypocalcemia with tetany.
C. Hypercalcemia with nephrolithiasis and bone loss.
D. Hyperkalemia from aldosterone deficiency in every case.
Correct Answer: C. Hypercalcemia with nephrolithiasis and bone loss.
Rationale: Excess parathyroid hormone raises serum calcium through bone, renal, and vitamin D effects. Kidney stones and reduced bone
density are important complications.
, 4. A patient with DKA has potassium 3.1 mEq/L before the insulin infusion is started. Which action should the nurse
anticipate?
A. Start insulin immediately at a high dose and ignore the potassium.
B. Hold insulin temporarily and replace potassium as prescribed until the level is safe.
C. Give sodium polystyrene sulfonate to lower potassium further.
D. Administer IV calcium solely to treat the low potassium.
Correct Answer: B. Hold insulin temporarily and replace potassium as prescribed until the level is safe.
Rationale: Insulin shifts potassium into cells and can cause life-threatening hypokalemia. When potassium is significantly low, potassium
replacement precedes insulin until the level reaches a safe threshold.
5. A patient with hyperthyroidism develops temperature 104.2 F, HR 162/min, agitation, vomiting, and heart failure
signs after surgery. Which condition requires immediate treatment?
A. Stable euthyroid state.
B. Uncomplicated hypoparathyroidism.
C. Myxedema coma.
D. Thyroid storm.
Correct Answer: D. Thyroid storm.
Rationale: Thyroid storm is life-threatening extreme thyrotoxicosis with high fever, marked tachycardia, CNS changes, and organ
dysfunction. Cooling, beta blockade when appropriate, antithyroid therapy, iodine after thionamide, steroids, and supportive care may be
needed.
6. Which pattern is most consistent with central diabetes insipidus?
A. Weight gain with low serum osmolality and no thirst.
B. Edema with concentrated urine caused by excessive ADH.
C. Low urine output with hyponatremia and concentrated urine.
D. Large volumes of dilute urine, intense thirst, increased serum sodium, and increased serum osmolality.
Correct Answer: D. Large volumes of dilute urine, intense thirst, increased serum sodium, and increased serum osmolality.
Rationale: Deficient ADH action causes inability to concentrate urine, producing polyuria and free-water loss. Serum sodium and osmolality
rise unless intake keeps pace.
7. Which statement by a patient with chronic SIADH indicates correct understanding of fluid restriction?
A. "I should drink extra fluid whenever my sodium is low."
B. "Only plain water counts as fluid."
C. "I will count liquids such as soup, gelatin, ice, and beverages toward my daily fluid allowance."
D. "Daily weight is not useful for this condition."
Correct Answer: C. "I will count liquids such as soup, gelatin, ice, and beverages toward my daily fluid allowance."
Rationale: Fluid restriction includes all sources that are liquid at room temperature. Daily weight, intake/output, sodium, and neurologic
status help monitor water balance and treatment response.
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Exam 2
1. Twelve hours after pituitary surgery, a patient has urine output 350 mL/hr for 3 hours, intense thirst, urine specific
gravity 1.002, and rising serum sodium. Which complication is most likely?
A. Diabetes insipidus.
B. Adrenal crisis caused by excess aldosterone.
C. Myxedema coma.
D. SIADH.
Correct Answer: A. Diabetes insipidus.
Rationale: Abrupt high-volume dilute urine with hypernatremia after pituitary surgery suggests deficient ADH activity and central DI. Fluid
balance, sodium, and need for desmopressin require prompt attention.
2. Which statement by a patient taking chronic glucocorticoid replacement for adrenal insufficiency indicates correct
understanding?
A. "I should stop steroids whenever I have a fever."
B. "I do not need a medical alert identification."
C. "I may need a higher stress dose during serious illness or surgery and should never stop the medication abruptly."
D. "Vomiting for a day is harmless because the drug remains stored in the body."
Correct Answer: C. "I may need a higher stress dose during serious illness or surgery and should never stop the medication
abruptly."
Rationale: Patients with adrenal insufficiency need uninterrupted glucocorticoid replacement and often increased dosing during physiologic
stress. Inability to retain oral medication can precipitate adrenal crisis and requires urgent care.
3. Which problem is commonly associated with primary hyperparathyroidism?
A. Severe hyponatremia from excess ADH as the defining feature.
B. Profound hypocalcemia with tetany.
C. Hypercalcemia with nephrolithiasis and bone loss.
D. Hyperkalemia from aldosterone deficiency in every case.
Correct Answer: C. Hypercalcemia with nephrolithiasis and bone loss.
Rationale: Excess parathyroid hormone raises serum calcium through bone, renal, and vitamin D effects. Kidney stones and reduced bone
density are important complications.
, 4. A patient with DKA has potassium 3.1 mEq/L before the insulin infusion is started. Which action should the nurse
anticipate?
A. Start insulin immediately at a high dose and ignore the potassium.
B. Hold insulin temporarily and replace potassium as prescribed until the level is safe.
C. Give sodium polystyrene sulfonate to lower potassium further.
D. Administer IV calcium solely to treat the low potassium.
Correct Answer: B. Hold insulin temporarily and replace potassium as prescribed until the level is safe.
Rationale: Insulin shifts potassium into cells and can cause life-threatening hypokalemia. When potassium is significantly low, potassium
replacement precedes insulin until the level reaches a safe threshold.
5. A patient with hyperthyroidism develops temperature 104.2 F, HR 162/min, agitation, vomiting, and heart failure
signs after surgery. Which condition requires immediate treatment?
A. Stable euthyroid state.
B. Uncomplicated hypoparathyroidism.
C. Myxedema coma.
D. Thyroid storm.
Correct Answer: D. Thyroid storm.
Rationale: Thyroid storm is life-threatening extreme thyrotoxicosis with high fever, marked tachycardia, CNS changes, and organ
dysfunction. Cooling, beta blockade when appropriate, antithyroid therapy, iodine after thionamide, steroids, and supportive care may be
needed.
6. Which pattern is most consistent with central diabetes insipidus?
A. Weight gain with low serum osmolality and no thirst.
B. Edema with concentrated urine caused by excessive ADH.
C. Low urine output with hyponatremia and concentrated urine.
D. Large volumes of dilute urine, intense thirst, increased serum sodium, and increased serum osmolality.
Correct Answer: D. Large volumes of dilute urine, intense thirst, increased serum sodium, and increased serum osmolality.
Rationale: Deficient ADH action causes inability to concentrate urine, producing polyuria and free-water loss. Serum sodium and osmolality
rise unless intake keeps pace.
7. Which statement by a patient with chronic SIADH indicates correct understanding of fluid restriction?
A. "I should drink extra fluid whenever my sodium is low."
B. "Only plain water counts as fluid."
C. "I will count liquids such as soup, gelatin, ice, and beverages toward my daily fluid allowance."
D. "Daily weight is not useful for this condition."
Correct Answer: C. "I will count liquids such as soup, gelatin, ice, and beverages toward my daily fluid allowance."
Rationale: Fluid restriction includes all sources that are liquid at room temperature. Daily weight, intake/output, sodium, and neurologic
status help monitor water balance and treatment response.
