NRSG 201 Exam 4 V2 | NRSG 201 Med Surg 1 |
Actual Q&A with Rationale (NRSG201 Exam 4) | Ivy
Tech
1. A client is diagnosed with hyperthyroidism and is prescribed propylthiouracil (PTU). Which
laboratory value should the nurse monitor most closely for potential life-threatening
complications?
A. Serum sodium levels
B. Blood glucose levels
C. Serum potassium levels
D. White blood cell (WBC) count
Correct Answer: D
Explanation: PTU can cause agranulocytosis, which is a severe reduction in the white
blood cell count that increases the risk of serious infection. The nurse should monitor the
WBC count and instruct the client to report any fever or sore throat immediately. This
laboratory assessment is vital for identifying this rare but life-threatening side effect of
antithyroid medications.
2. The nurse is providing discharge instructions to a client with Addison’s disease regarding
corticosteroid replacement therapy. Which instruction is most critical for the nurse to
include?
A. Decrease the dose during periods of emotional stress.
,B. Carry a medical alert identification at all times
C. Avoid taking the medication with food or milk.
D. Discontinue the medication if weight gain occurs.
Correct Answer: B
Explanation: Clients with Addison’s disease require lifelong hormone replacement and
must wear a medical alert bracelet to ensure proper treatment during an emergency.
Sudden stressors can trigger an Addisonian crisis, which is a medical emergency requiring
rapid intervention. Carrying identification ensures that emergency responders are aware of
the need for glucocorticoids if the client becomes incapacitated.
3. A client presents with symptoms of polyuria, polydipsia, and a fruity odor to the breath.
The blood glucose is 450 mg/dL. Which acid-base imbalance does the nurse anticipate?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
Correct Answer: A
Explanation: These clinical manifestations are classic signs of Diabetic Ketoacidosis (DKA),
which leads to an accumulation of ketones in the blood. Ketones are acidic, resulting in a
decrease in serum pH and the development of metabolic acidosis. The nurse must
, recognize these signs quickly to initiate fluid resuscitation and insulin therapy to correct
the pH imbalance.
4. A nurse is caring for a client who underwent a subtotal thyroidectomy. The client reports
tingling in the fingers and toes. Which action should the nurse take first?
A. Assess the surgical dressing for bleeding.
B. Check the client’s blood pressure.
C. Administer a prescribed analgesic.
D. Assess for Chvostek’s sign
Correct Answer: D
Explanation: Tingling in the extremities (paresthesia) is a sign of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy. Chvostek’s sign is a clinical indicator of hypocalcemia elicited by tapping
the facial nerve. Identifying this early allows the nurse to prevent progression to tetany and
potential airway obstruction.
5. A client with Type 2 Diabetes is scheduled for a CT scan with IV contrast. Which medication
must the nurse ensure is withheld for 48 hours after the procedure?
A. Glyburide
B. Glulisine
C. Metformin
Actual Q&A with Rationale (NRSG201 Exam 4) | Ivy
Tech
1. A client is diagnosed with hyperthyroidism and is prescribed propylthiouracil (PTU). Which
laboratory value should the nurse monitor most closely for potential life-threatening
complications?
A. Serum sodium levels
B. Blood glucose levels
C. Serum potassium levels
D. White blood cell (WBC) count
Correct Answer: D
Explanation: PTU can cause agranulocytosis, which is a severe reduction in the white
blood cell count that increases the risk of serious infection. The nurse should monitor the
WBC count and instruct the client to report any fever or sore throat immediately. This
laboratory assessment is vital for identifying this rare but life-threatening side effect of
antithyroid medications.
2. The nurse is providing discharge instructions to a client with Addison’s disease regarding
corticosteroid replacement therapy. Which instruction is most critical for the nurse to
include?
A. Decrease the dose during periods of emotional stress.
,B. Carry a medical alert identification at all times
C. Avoid taking the medication with food or milk.
D. Discontinue the medication if weight gain occurs.
Correct Answer: B
Explanation: Clients with Addison’s disease require lifelong hormone replacement and
must wear a medical alert bracelet to ensure proper treatment during an emergency.
Sudden stressors can trigger an Addisonian crisis, which is a medical emergency requiring
rapid intervention. Carrying identification ensures that emergency responders are aware of
the need for glucocorticoids if the client becomes incapacitated.
3. A client presents with symptoms of polyuria, polydipsia, and a fruity odor to the breath.
The blood glucose is 450 mg/dL. Which acid-base imbalance does the nurse anticipate?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
Correct Answer: A
Explanation: These clinical manifestations are classic signs of Diabetic Ketoacidosis (DKA),
which leads to an accumulation of ketones in the blood. Ketones are acidic, resulting in a
decrease in serum pH and the development of metabolic acidosis. The nurse must
, recognize these signs quickly to initiate fluid resuscitation and insulin therapy to correct
the pH imbalance.
4. A nurse is caring for a client who underwent a subtotal thyroidectomy. The client reports
tingling in the fingers and toes. Which action should the nurse take first?
A. Assess the surgical dressing for bleeding.
B. Check the client’s blood pressure.
C. Administer a prescribed analgesic.
D. Assess for Chvostek’s sign
Correct Answer: D
Explanation: Tingling in the extremities (paresthesia) is a sign of hypocalcemia, which can
occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy. Chvostek’s sign is a clinical indicator of hypocalcemia elicited by tapping
the facial nerve. Identifying this early allows the nurse to prevent progression to tetany and
potential airway obstruction.
5. A client with Type 2 Diabetes is scheduled for a CT scan with IV contrast. Which medication
must the nurse ensure is withheld for 48 hours after the procedure?
A. Glyburide
B. Glulisine
C. Metformin
