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NSG 4100 EXAM 2 BLUEPRINT AT GALEN COLLEGE OF NURSING. EXAM —
COMPREHENSIVE —EXAM QUESTIONS LATEST EDITION 2026 – 2027
VERSION SOLVED QUESTIONS & ANSWERS
1. Which of the following best describes the primary pathophysiologic mechanism
responsible for the clinical manifestations of SIADH?
A. Excessive renal water excretion leading to hypernatremia and polyuria
B. Excessive release of antidiuretic hormone causing water retention and dilutional
hyponatremia
C. Deficient secretion of antidiuretic hormone resulting in massive diuresis and
dehydration
D. Primary aldosterone deficiency producing sodium wasting and volume depletion
Answer: B
Rationale: SIADH is characterized by excessive ADH secretion from the posterior
pituitary or ectopic sources, leading to increased water reabsorption in the collecting
ducts. This results in concentrated urine, fluid retention, and dilutional hyponatremia .
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2. A nurse is assessing a client who underwent a transsphenoidal hypophysectomy.
Which finding requires immediate notification of the healthcare provider?
A. The client reports a headache rated 3/10
B. Clear nasal drainage that tests positive for glucose
C. Urine output of 45 mL over the past hour
D. Blood pressure reading of 128/76 mm Hg
Answer: B
Rationale: Clear nasal drainage after transsphenoidal hypophysectomy may indicate a
cerebrospinal fluid leak, which is confirmed by a positive glucose test. This requires
immediate intervention to prevent meningitis .
3. What is the primary function of desmopressin in the management of diabetes
insipidus?
A. It stimulates aldosterone release to promote sodium retention
B. It replaces deficient antidiuretic hormone to reduce urine output
C. It blocks ADH receptors to prevent water reabsorption
D. It increases renal perfusion to enhance glomerular filtration
Answer: B
Rationale: Desmopressin is a synthetic analog of antidiuretic hormone used to treat
diabetes insipidus. It works by replacing the missing ADH, thereby reducing urine output
and increasing urine concentration .
4. In the context of adrenal insufficiency, which electrolyte imbalance is most
characteristic of Addisonian crisis?
A. Hypernatremia and hypokalemia
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B. Hyperkalemia and hyponatremia
C. Hypercalcemia and hyperphosphatemia
D. Hypokalemia and hyperglycemia
Answer: B
Rationale: Addisonian crisis results from aldosterone deficiency, which leads to
sodium loss and potassium retention. This produces hyponatremia, hyperkalemia, and
hypotension .
5. A patient with Cushing's disease is at increased risk for which complication due
to the effects of excess cortisol?
A. Hyperglycemia and poor wound healing
B. Hypotension and weight loss
C. Hypokalemia and muscle hypertrophy
D. Bradycardia and constipation
Answer: A
Rationale: Excess cortisol promotes gluconeogenesis and insulin resistance, leading to
hyperglycemia. It also impairs collagen synthesis and immune function, resulting in
poor wound healing .
6. A client with a diagnosis of Addisonian crisis is being admitted to the ICU. Which
findings will the interprofessional care team focus on? Select all that apply.
A. Hypotension
B. Leukocytosis
C. Hyperkalemia
D. Hypercalcemia
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E. Hypernatremia
Answer: A, C
Rationale: Addisonian crisis is characterized by hypotension, hyperkalemia,
hyponatremia, and hypoglycemia due to combined cortisol and aldosterone deficiency .
7. A nurse is caring for a client after hypophysectomy and notes clear nasal
drainage from the client's nostril. The nurse should take which initial action?
A. Lower the head of the bed
B. Test drainage for glucose
C. Obtain culture of drainage
D. Continue to observe drainage
Answer: B
Rationale: Clear nasal drainage after hypophysectomy may indicate a CSF leak. Testing
for glucose helps confirm the presence of CSF, which requires immediate intervention .
8. A nurse is admitting a client who is diagnosed with SIADH and has a serum
sodium of 118 mEq/L. Which physician prescription should the nurse anticipate
receiving? Select all that apply.
A. Initiate infusion of 3% NaCl
B. Administer IV furosemide
C. Restrict fluids to 800 mL over 24 hours
D. Elevate HOB to high Fowler's
E. Administer a vasopressin antagonist as prescribed
Answer: A, C, E
Rationale: Severe hyponatremia in SIADH is managed with hypertonic saline (3% NaCl),
NSG 4100 EXAM 2 BLUEPRINT AT GALEN COLLEGE OF NURSING. EXAM —
COMPREHENSIVE —EXAM QUESTIONS LATEST EDITION 2026 – 2027
VERSION SOLVED QUESTIONS & ANSWERS
1. Which of the following best describes the primary pathophysiologic mechanism
responsible for the clinical manifestations of SIADH?
A. Excessive renal water excretion leading to hypernatremia and polyuria
B. Excessive release of antidiuretic hormone causing water retention and dilutional
hyponatremia
C. Deficient secretion of antidiuretic hormone resulting in massive diuresis and
dehydration
D. Primary aldosterone deficiency producing sodium wasting and volume depletion
Answer: B
Rationale: SIADH is characterized by excessive ADH secretion from the posterior
pituitary or ectopic sources, leading to increased water reabsorption in the collecting
ducts. This results in concentrated urine, fluid retention, and dilutional hyponatremia .
, Page 2 of 98
2. A nurse is assessing a client who underwent a transsphenoidal hypophysectomy.
Which finding requires immediate notification of the healthcare provider?
A. The client reports a headache rated 3/10
B. Clear nasal drainage that tests positive for glucose
C. Urine output of 45 mL over the past hour
D. Blood pressure reading of 128/76 mm Hg
Answer: B
Rationale: Clear nasal drainage after transsphenoidal hypophysectomy may indicate a
cerebrospinal fluid leak, which is confirmed by a positive glucose test. This requires
immediate intervention to prevent meningitis .
3. What is the primary function of desmopressin in the management of diabetes
insipidus?
A. It stimulates aldosterone release to promote sodium retention
B. It replaces deficient antidiuretic hormone to reduce urine output
C. It blocks ADH receptors to prevent water reabsorption
D. It increases renal perfusion to enhance glomerular filtration
Answer: B
Rationale: Desmopressin is a synthetic analog of antidiuretic hormone used to treat
diabetes insipidus. It works by replacing the missing ADH, thereby reducing urine output
and increasing urine concentration .
4. In the context of adrenal insufficiency, which electrolyte imbalance is most
characteristic of Addisonian crisis?
A. Hypernatremia and hypokalemia
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B. Hyperkalemia and hyponatremia
C. Hypercalcemia and hyperphosphatemia
D. Hypokalemia and hyperglycemia
Answer: B
Rationale: Addisonian crisis results from aldosterone deficiency, which leads to
sodium loss and potassium retention. This produces hyponatremia, hyperkalemia, and
hypotension .
5. A patient with Cushing's disease is at increased risk for which complication due
to the effects of excess cortisol?
A. Hyperglycemia and poor wound healing
B. Hypotension and weight loss
C. Hypokalemia and muscle hypertrophy
D. Bradycardia and constipation
Answer: A
Rationale: Excess cortisol promotes gluconeogenesis and insulin resistance, leading to
hyperglycemia. It also impairs collagen synthesis and immune function, resulting in
poor wound healing .
6. A client with a diagnosis of Addisonian crisis is being admitted to the ICU. Which
findings will the interprofessional care team focus on? Select all that apply.
A. Hypotension
B. Leukocytosis
C. Hyperkalemia
D. Hypercalcemia
, Page 4 of 98
E. Hypernatremia
Answer: A, C
Rationale: Addisonian crisis is characterized by hypotension, hyperkalemia,
hyponatremia, and hypoglycemia due to combined cortisol and aldosterone deficiency .
7. A nurse is caring for a client after hypophysectomy and notes clear nasal
drainage from the client's nostril. The nurse should take which initial action?
A. Lower the head of the bed
B. Test drainage for glucose
C. Obtain culture of drainage
D. Continue to observe drainage
Answer: B
Rationale: Clear nasal drainage after hypophysectomy may indicate a CSF leak. Testing
for glucose helps confirm the presence of CSF, which requires immediate intervention .
8. A nurse is admitting a client who is diagnosed with SIADH and has a serum
sodium of 118 mEq/L. Which physician prescription should the nurse anticipate
receiving? Select all that apply.
A. Initiate infusion of 3% NaCl
B. Administer IV furosemide
C. Restrict fluids to 800 mL over 24 hours
D. Elevate HOB to high Fowler's
E. Administer a vasopressin antagonist as prescribed
Answer: A, C, E
Rationale: Severe hyponatremia in SIADH is managed with hypertonic saline (3% NaCl),
