NSG 4100 Exam 3 – Advanced Medical-Surgical
Nursing.
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SECTION 1: LABORATORY INTERPRETATION AND PATHOPHYSIOLOGY (Questions
1–20)
**1.** A nurse reviews the laboratory results of a client admitted with suspected liver
dysfunction: Hgb 9.5 g/dL, Hct 38%, Bilirubin 5.3 mg/dL, ALT 51 units/L, AST 48 units/L,
ALP 151 units/L, Platelets 100,000/mm³, Creatinine 1.8 mg/dL, Total protein 15 g/dL.
Which finding is most indicative of impaired hepatic synthetic function?
A. Elevated bilirubin
B. Thrombocytopenia
C. Elevated total protein
D. Elevated creatinine
**Correct Answer:** B
**2.** A client has the following labs: ALT 51 units/L (normal 4–36), AST 48 units/L
(normal 0–35), ALP 151 units/L (normal 30–120). The nurse recognizes these values
collectively suggest:
A. Acute viral hepatitis
B. Cholestatic liver injury
C. Hepatocellular injury with possible biliary obstruction
D. Normal variation in an older adult
,**Correct Answer:** C
**3.** Which laboratory value is most critical for the nurse to monitor in a client with
elevated bilirubin and jaundice?
A. Serum albumin
B. Prothrombin time (PT/INR)
C. Serum potassium
D. Blood urea nitrogen
**Correct Answer:** B
**4.** A client’s labs show Hgb 9.5 g/dL and platelets 100,000/mm³. The nurse
understands these findings increase the risk for:
A. Spontaneous bleeding and fatigue
B. Fluid volume overload
C. Hyperglycemia
D. Respiratory acidosis
**Correct Answer:** A
**5.** Elevated serum ammonia in a client with liver dysfunction is primarily caused by
the liver’s inability to:
A. Convert ammonia to urea
B. Produce clotting factors
C. Store glycogen
D. Conjugate bilirubin
**Correct Answer:** A
, **6.** A client with chronic liver disease has a total protein of 15 g/dL. The nurse should
investigate for:
A. Dehydration or multiple myeloma
B. Severe malnutrition
C. Acute kidney injury only
D. Normal finding in cirrhosis
**Correct Answer:** A
**7.** Which electrolyte imbalance is most expected in a client with ascites and elevated
creatinine secondary to hepatorenal syndrome?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
**Correct Answer:** B
**8.** The nurse notes a client’s bilirubin is 5.3 mg/dL. This level places the client at
highest risk for:
A. Pruritus and skin breakdown
B. Hypoglycemia
C. Hypertension
D. Increased urine output
**Correct Answer:** A
Nursing.
---
SECTION 1: LABORATORY INTERPRETATION AND PATHOPHYSIOLOGY (Questions
1–20)
**1.** A nurse reviews the laboratory results of a client admitted with suspected liver
dysfunction: Hgb 9.5 g/dL, Hct 38%, Bilirubin 5.3 mg/dL, ALT 51 units/L, AST 48 units/L,
ALP 151 units/L, Platelets 100,000/mm³, Creatinine 1.8 mg/dL, Total protein 15 g/dL.
Which finding is most indicative of impaired hepatic synthetic function?
A. Elevated bilirubin
B. Thrombocytopenia
C. Elevated total protein
D. Elevated creatinine
**Correct Answer:** B
**2.** A client has the following labs: ALT 51 units/L (normal 4–36), AST 48 units/L
(normal 0–35), ALP 151 units/L (normal 30–120). The nurse recognizes these values
collectively suggest:
A. Acute viral hepatitis
B. Cholestatic liver injury
C. Hepatocellular injury with possible biliary obstruction
D. Normal variation in an older adult
,**Correct Answer:** C
**3.** Which laboratory value is most critical for the nurse to monitor in a client with
elevated bilirubin and jaundice?
A. Serum albumin
B. Prothrombin time (PT/INR)
C. Serum potassium
D. Blood urea nitrogen
**Correct Answer:** B
**4.** A client’s labs show Hgb 9.5 g/dL and platelets 100,000/mm³. The nurse
understands these findings increase the risk for:
A. Spontaneous bleeding and fatigue
B. Fluid volume overload
C. Hyperglycemia
D. Respiratory acidosis
**Correct Answer:** A
**5.** Elevated serum ammonia in a client with liver dysfunction is primarily caused by
the liver’s inability to:
A. Convert ammonia to urea
B. Produce clotting factors
C. Store glycogen
D. Conjugate bilirubin
**Correct Answer:** A
, **6.** A client with chronic liver disease has a total protein of 15 g/dL. The nurse should
investigate for:
A. Dehydration or multiple myeloma
B. Severe malnutrition
C. Acute kidney injury only
D. Normal finding in cirrhosis
**Correct Answer:** A
**7.** Which electrolyte imbalance is most expected in a client with ascites and elevated
creatinine secondary to hepatorenal syndrome?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
**Correct Answer:** B
**8.** The nurse notes a client’s bilirubin is 5.3 mg/dL. This level places the client at
highest risk for:
A. Pruritus and skin breakdown
B. Hypoglycemia
C. Hypertension
D. Increased urine output
**Correct Answer:** A
