NSG 4100- Adult Health III Assessment 2 with
Complete Solutions
Endocrine disorders
Metabolic emergencies
Renal pathology
Cardiac perfusion
Neurological emergencies
Complex patient care
Q1. A patient with diabetic ketoacidosis (DKA) presents with Kussmaul respirations.
What is the primary purpose of this breathing pattern?
• Answer: To blow off excess CO₂ and reduce metabolic acidosis.
• Rationale: Kussmaul respirations are deep, rapid breaths that compensate for
metabolic acidosis by lowering carbon dioxide levels, helping restore acid-base
balance.
Q2. A patient with Addison’s disease is admitted with severe hypotension and
confusion. What immediate intervention is expected?
• Answer: IV hydrocortisone administration.
• Rationale: Addisonian crisis is life-threatening due to cortisol deficiency.
Hydrocortisone rapidly replaces glucocorticoids, stabilizing blood pressure and
preventing shock.
Q3. A nurse is caring for a patient with acute pancreatitis. Which intervention is most
appropriate?
• Answer: Keep the patient NPO and administer IV fluids.
• Rationale: NPO prevents pancreatic stimulation from food intake. IV fluids
correct hypovolemia caused by third-spacing and vomiting.
Q4. A patient with SIADH has serum sodium of 118 mEq/L. What is the priority nursing
action?
• Answer: Restrict fluid intake.
• Rationale: SIADH causes dilutional hyponatremia. Fluid restriction prevents
worsening of sodium imbalance and neurological complications.
Q5. A patient with pheochromocytoma reports severe headache and palpitations. What
is the nurse’s immediate concern?
, • Answer: Hypertensive crisis.
• Rationale: Excess catecholamine release causes dangerous spikes in blood
pressure, risking stroke or cardiac complications. Monitoring and rapid
intervention are critical.
Q6. A patient with chronic kidney disease has a serum potassium of 6.2 mEq/L. Which
intervention is most urgent?
• Answer: Administer IV calcium gluconate.
• Rationale: Hyperkalemia can cause life-threatening arrhythmias. Calcium
gluconate stabilizes cardiac membranes immediately, while other measures
(insulin, dialysis) lower potassium more gradually.
Q7. A patient with cirrhosis develops ascites. What is the primary mechanism causing
this complication?
• Answer: Portal hypertension and hypoalbuminemia.
• Rationale: Increased pressure in the portal vein and reduced plasma oncotic
pressure from low albumin lead to fluid accumulation in the peritoneal cavity.
Q8. A patient with myasthenia gravis is scheduled for surgery. Which preoperative
medication is most important?
• Answer: Anticholinesterase (e.g., pyridostigmine).
• Rationale: Ensures adequate neuromuscular transmission and prevents
respiratory muscle weakness during anesthesia.
Q9. A patient with heart failure is prescribed digoxin. Which finding requires immediate
intervention?
• Answer: Serum potassium of 2.8 mEq/L.
• Rationale: Hypokalemia increases digoxin toxicity risk, leading to arrhythmias.
Potassium must be corrected before continuing therapy.
Q10. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notices increasing drowsiness. What is the likely cause?
• Answer: Oxygen-induced hypoventilation.
• Rationale: High oxygen flow can suppress hypoxic drive in COPD patients,
leading to CO₂ retention and respiratory acidosis.
Q11. A patient with hypothyroidism is prescribed levothyroxine. Which teaching point is
most important?
• Answer: Take the medication on an empty stomach in the morning.
, • Rationale: Absorption is best when taken before breakfast; food and other
medications interfere with effectiveness.
Q12. A patient with Cushing’s syndrome presents with purple striae and truncal obesity.
What is the underlying cause?
• Answer: Excess cortisol secretion.
• Rationale: Cortisol promotes fat redistribution, protein breakdown, and skin
changes, leading to characteristic features.
Q13. A patient with acute renal failure has a urine output of 200 mL in 24 hours. What
stage is this?
• Answer: Oliguric phase.
• Rationale: Oliguria is defined as <400 mL/day, indicating impaired renal function
and fluid retention.
Q14. A patient with hyperthyroidism is scheduled for thyroidectomy. Which preoperative
medication reduces vascularity of the gland?
• Answer: Lugol’s iodine solution.
• Rationale: Iodine decreases thyroid hormone release and reduces gland
vascularity, lowering surgical risk.
Q15. A patient with multiple sclerosis reports blurred vision and muscle weakness. What
is the pathophysiology?
• Answer: Demyelination of nerve fibers.
• Rationale: MS is an autoimmune disease that destroys myelin, impairing nerve
conduction and causing neurological deficits.
Q16. A patient with chronic heart failure is prescribed spironolactone. What lab value
must be monitored closely?
• Answer: Serum potassium.
• Rationale: Spironolactone is potassium-sparing; hyperkalemia can occur,
increasing risk of arrhythmias.
Q17. A patient with acute stroke suddenly develops difficulty speaking. What is the term
for this?
• Answer: Aphasia.
• Rationale: Aphasia is impaired language ability due to damage in the dominant
cerebral hemisphere (usually left).
Q18. A patient with COPD is prescribed theophylline. Which finding suggests toxicity?
Complete Solutions
Endocrine disorders
Metabolic emergencies
Renal pathology
Cardiac perfusion
Neurological emergencies
Complex patient care
Q1. A patient with diabetic ketoacidosis (DKA) presents with Kussmaul respirations.
What is the primary purpose of this breathing pattern?
• Answer: To blow off excess CO₂ and reduce metabolic acidosis.
• Rationale: Kussmaul respirations are deep, rapid breaths that compensate for
metabolic acidosis by lowering carbon dioxide levels, helping restore acid-base
balance.
Q2. A patient with Addison’s disease is admitted with severe hypotension and
confusion. What immediate intervention is expected?
• Answer: IV hydrocortisone administration.
• Rationale: Addisonian crisis is life-threatening due to cortisol deficiency.
Hydrocortisone rapidly replaces glucocorticoids, stabilizing blood pressure and
preventing shock.
Q3. A nurse is caring for a patient with acute pancreatitis. Which intervention is most
appropriate?
• Answer: Keep the patient NPO and administer IV fluids.
• Rationale: NPO prevents pancreatic stimulation from food intake. IV fluids
correct hypovolemia caused by third-spacing and vomiting.
Q4. A patient with SIADH has serum sodium of 118 mEq/L. What is the priority nursing
action?
• Answer: Restrict fluid intake.
• Rationale: SIADH causes dilutional hyponatremia. Fluid restriction prevents
worsening of sodium imbalance and neurological complications.
Q5. A patient with pheochromocytoma reports severe headache and palpitations. What
is the nurse’s immediate concern?
, • Answer: Hypertensive crisis.
• Rationale: Excess catecholamine release causes dangerous spikes in blood
pressure, risking stroke or cardiac complications. Monitoring and rapid
intervention are critical.
Q6. A patient with chronic kidney disease has a serum potassium of 6.2 mEq/L. Which
intervention is most urgent?
• Answer: Administer IV calcium gluconate.
• Rationale: Hyperkalemia can cause life-threatening arrhythmias. Calcium
gluconate stabilizes cardiac membranes immediately, while other measures
(insulin, dialysis) lower potassium more gradually.
Q7. A patient with cirrhosis develops ascites. What is the primary mechanism causing
this complication?
• Answer: Portal hypertension and hypoalbuminemia.
• Rationale: Increased pressure in the portal vein and reduced plasma oncotic
pressure from low albumin lead to fluid accumulation in the peritoneal cavity.
Q8. A patient with myasthenia gravis is scheduled for surgery. Which preoperative
medication is most important?
• Answer: Anticholinesterase (e.g., pyridostigmine).
• Rationale: Ensures adequate neuromuscular transmission and prevents
respiratory muscle weakness during anesthesia.
Q9. A patient with heart failure is prescribed digoxin. Which finding requires immediate
intervention?
• Answer: Serum potassium of 2.8 mEq/L.
• Rationale: Hypokalemia increases digoxin toxicity risk, leading to arrhythmias.
Potassium must be corrected before continuing therapy.
Q10. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notices increasing drowsiness. What is the likely cause?
• Answer: Oxygen-induced hypoventilation.
• Rationale: High oxygen flow can suppress hypoxic drive in COPD patients,
leading to CO₂ retention and respiratory acidosis.
Q11. A patient with hypothyroidism is prescribed levothyroxine. Which teaching point is
most important?
• Answer: Take the medication on an empty stomach in the morning.
, • Rationale: Absorption is best when taken before breakfast; food and other
medications interfere with effectiveness.
Q12. A patient with Cushing’s syndrome presents with purple striae and truncal obesity.
What is the underlying cause?
• Answer: Excess cortisol secretion.
• Rationale: Cortisol promotes fat redistribution, protein breakdown, and skin
changes, leading to characteristic features.
Q13. A patient with acute renal failure has a urine output of 200 mL in 24 hours. What
stage is this?
• Answer: Oliguric phase.
• Rationale: Oliguria is defined as <400 mL/day, indicating impaired renal function
and fluid retention.
Q14. A patient with hyperthyroidism is scheduled for thyroidectomy. Which preoperative
medication reduces vascularity of the gland?
• Answer: Lugol’s iodine solution.
• Rationale: Iodine decreases thyroid hormone release and reduces gland
vascularity, lowering surgical risk.
Q15. A patient with multiple sclerosis reports blurred vision and muscle weakness. What
is the pathophysiology?
• Answer: Demyelination of nerve fibers.
• Rationale: MS is an autoimmune disease that destroys myelin, impairing nerve
conduction and causing neurological deficits.
Q16. A patient with chronic heart failure is prescribed spironolactone. What lab value
must be monitored closely?
• Answer: Serum potassium.
• Rationale: Spironolactone is potassium-sparing; hyperkalemia can occur,
increasing risk of arrhythmias.
Q17. A patient with acute stroke suddenly develops difficulty speaking. What is the term
for this?
• Answer: Aphasia.
• Rationale: Aphasia is impaired language ability due to damage in the dominant
cerebral hemisphere (usually left).
Q18. A patient with COPD is prescribed theophylline. Which finding suggests toxicity?
