NU 186 Exam 4 V3 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 4) | Galen
1. A nurse is caring for a client admitted with Diabetic Ketoacidosis (DKA). Which of the
following laboratory results should the nurse expect?
A. Blood glucose 180 mg/dL, pH 7.38
B. Blood glucose 450 mg/dL, pH 7.20
C. Blood glucose 800 mg/dL, pH 7.45
D. Blood glucose 300 mg/dL, HCO3 24 mEq/L
Correct Answer: B
Explanation: Diabetic Ketoacidosis is characterized by hyperglycemia (usually >250
mg/dL) and metabolic acidosis with a pH below 7.35. The presence of ketones leads to a
decrease in serum pH and bicarbonate levels. Option B represents both the elevated
glucose and the acidic state typical of this emergency.
2. A client is diagnosed with Hyperglycemic Hyperosmolar State (HHS). The nurse understands
that which clinical manifestation distinguishes HHS from DKA?
A. Profound dehydration
B. Absence of significant ketosis
C. Altered mental status
,D. Extremely high blood glucose
Correct Answer: B
Explanation: HHS occurs primarily in type 2 diabetics who have enough insulin to prevent
the breakdown of fats into ketones, but not enough to control blood glucose levels. While
both conditions involve dehydration and high glucose, DKA is defined by ketosis and
acidosis, which are absent in HHS. This distinction is critical for determining the
appropriate treatment protocol for the client.
3. The nurse is providing care for a client diagnosed with end-stage liver disease (ESLD).
Which assessment findings are indicative of hepatic encephalopathy? Select all that apply.
A. Tremors
B. Impaired consciousness
C. Inappropriate behavior
D. Dyspnea
E. Asterixis
F. Fetor hepaticus
Correct Answer: A,B,C,E,F
Explanation: Hepatic encephalopathy results from the accumulation of ammonia in the
blood, which crosses the blood-brain barrier. Asterixis (liver flap) and fetor hepaticus
(musty breath odor) are classic late signs of this condition. Behavioral changes and altered
, levels of consciousness indicate progressive neurological impairment due to toxin
accumulation.
4. A client with Addison’s disease is admitted for an elective procedure. Which medication
order should the nurse clarify with the healthcare provider?
A. Spironolactone 25 mg PO
B. Fludrocortisone 0.1 mg PO
C. Hydrocortisone 100 mg IV
D. Normal Saline infusion at 125 mL/hr
Correct Answer: A
Explanation: Spironolactone is a potassium-sparing diuretic, which is contraindicated in
Addison’s disease because these clients are already at high risk for hyperkalemia due to
aldosterone deficiency. Hydrocortisone and Fludrocortisone are standard replacement
therapies for adrenal insufficiency. Intravenous fluids are often necessary to maintain
blood pressure and hydration in these clients.
5. The nurse is caring for a client following a subtotal thyroidectomy. Which assessment
finding is the most immediate priority?
A. Sore throat when swallowing
B. Laryngeal stridor
C. Hoarseness of the voice
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 4) | Galen
1. A nurse is caring for a client admitted with Diabetic Ketoacidosis (DKA). Which of the
following laboratory results should the nurse expect?
A. Blood glucose 180 mg/dL, pH 7.38
B. Blood glucose 450 mg/dL, pH 7.20
C. Blood glucose 800 mg/dL, pH 7.45
D. Blood glucose 300 mg/dL, HCO3 24 mEq/L
Correct Answer: B
Explanation: Diabetic Ketoacidosis is characterized by hyperglycemia (usually >250
mg/dL) and metabolic acidosis with a pH below 7.35. The presence of ketones leads to a
decrease in serum pH and bicarbonate levels. Option B represents both the elevated
glucose and the acidic state typical of this emergency.
2. A client is diagnosed with Hyperglycemic Hyperosmolar State (HHS). The nurse understands
that which clinical manifestation distinguishes HHS from DKA?
A. Profound dehydration
B. Absence of significant ketosis
C. Altered mental status
,D. Extremely high blood glucose
Correct Answer: B
Explanation: HHS occurs primarily in type 2 diabetics who have enough insulin to prevent
the breakdown of fats into ketones, but not enough to control blood glucose levels. While
both conditions involve dehydration and high glucose, DKA is defined by ketosis and
acidosis, which are absent in HHS. This distinction is critical for determining the
appropriate treatment protocol for the client.
3. The nurse is providing care for a client diagnosed with end-stage liver disease (ESLD).
Which assessment findings are indicative of hepatic encephalopathy? Select all that apply.
A. Tremors
B. Impaired consciousness
C. Inappropriate behavior
D. Dyspnea
E. Asterixis
F. Fetor hepaticus
Correct Answer: A,B,C,E,F
Explanation: Hepatic encephalopathy results from the accumulation of ammonia in the
blood, which crosses the blood-brain barrier. Asterixis (liver flap) and fetor hepaticus
(musty breath odor) are classic late signs of this condition. Behavioral changes and altered
, levels of consciousness indicate progressive neurological impairment due to toxin
accumulation.
4. A client with Addison’s disease is admitted for an elective procedure. Which medication
order should the nurse clarify with the healthcare provider?
A. Spironolactone 25 mg PO
B. Fludrocortisone 0.1 mg PO
C. Hydrocortisone 100 mg IV
D. Normal Saline infusion at 125 mL/hr
Correct Answer: A
Explanation: Spironolactone is a potassium-sparing diuretic, which is contraindicated in
Addison’s disease because these clients are already at high risk for hyperkalemia due to
aldosterone deficiency. Hydrocortisone and Fludrocortisone are standard replacement
therapies for adrenal insufficiency. Intravenous fluids are often necessary to maintain
blood pressure and hydration in these clients.
5. The nurse is caring for a client following a subtotal thyroidectomy. Which assessment
finding is the most immediate priority?
A. Sore throat when swallowing
B. Laryngeal stridor
C. Hoarseness of the voice
