Exam 1 v2: NSG 4100/ NSG 4100 – Latest 2026/2027
Update – Advanced Medical-Surgical Nursing
Questions with Verified Answers and Elaborated
Solutions Academic Year
Q1. A client who has been receiving radiation therapy for bladder cancer tells the
nurse that it feels as if she is voiding through the vagina. The nurse interprets that
the client may be experiencing which condition?
1. Rupture of the bladder
2. The development of a vesicovaginal fistula
3. Extreme stress caused by the diagnosis of cancer
4. Altered perineal sensation as a side effect of radiation therapy
Rationale: A vesicovaginal fistula is a genital fistula that occurs between the
bladder and vagina. The fistula is an abnormal opening between these two body
parts and, if this occurs, the client may experience drainage of urine through the
vagina. The client's complaint is not associated with options 1, 3, or 4.
Q2. The nurse is teaching a client about the risk factors associated with colorectal
cancer. The nurse determines that further teaching is necessary related to colorectal
cancer if the client identifies which item as an associated risk factor?
1. Age younger than 50 years
2. History of colorectal polyps
3. Family history of colorectal cancer
4. Chronic inflammatory bowel disease
Rationale: Risk factors for colorectal cancer include age older than 50 years, a
history of colorectal polyps, a family history of colorectal cancer, and chronic
inflammatory bowel disease. Identifying age younger than 50 years as a risk factor
indicates a need for further teaching.
,Q3. The nurse is reviewing the record of a client with a diagnosis of cirrhosis and
notes that there is documentation of the presence of asterixis. How should the
nurse assess for its presence?
1. Dorsiflex the client's foot
2. Measure the abdominal girth
3. Ask the client to extend the arms
4. Instruct the client to lean forward
Rationale: Asterixis is irregular flapping movements of the fingers and wrists
when the hands and arms are outstretched, with the palms down, wrists bent up,
and fingers spread. Asterixis is the most common and reliable sign that hepatic
encephalopathy is developing. Options 1, 2, and 4 are incorrect.
Q4. The nurse is reviewing the laboratory results for a client with cirrhosis and
notes that the ammonia level is 85 mcg/dL (51 mmol/L). Which dietary selection
does the nurse suggest to the client?
1. Roast pork
2. Cheese omelet
3. Pasta with sauce
4. Tuna fish sandwich
Rationale: Cirrhosis is a chronic, progressive disease of the liver characterized by
diffuse degeneration and destruction of hepatocytes. The serum ammonia level
assesses the ability of the liver to deaminate protein byproducts. Normal reference
interval is 10 to 80 mcg/dL (6 to 47 mmol/L). Most of the ammonia in the body is
found in the gastrointestinal tract. Protein provided by the diet is transported to the
liver by the portal vein. The liver breaks down protein, which results in the
formation of ammonia. Foods high in protein should be avoided since the client's
ammonia level is elevated above the normal range; therefore, pasta with sauce
(lower in protein) would be the best selection.
, Q5. The nurse is reviewing a client's record and notes that the health care provider
has documented that the client has chronic renal disease. On review of the
laboratory results, the nurse most likely would expect to note which finding?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
4. Increased number of white blood cells in the urine
Rationale: The creatinine level is the most specific laboratory test to determine
renal function. The creatinine level increases when at least 50% of renal function is
lost. A decreased hemoglobin level and red blood cell count are associated with
anemia or blood loss and not specifically with decreased renal function. Increased
white blood cells in the urine indicate a urinary tract infection.
Q6. A client with heart failure is prescribed furosemide. Which laboratory value
should the nurse monitor most closely?
1. Serum sodium
2. Serum potassium
3. Serum calcium
4. Serum magnesium
Rationale: Furosemide is a loop diuretic that causes excretion of potassium.
Hypokalemia can lead to cardiac dysrhythmias. While sodium, calcium, and
magnesium may also be affected, potassium imbalance is the most common and
dangerous adverse effect.
Q7. A client with chronic obstructive pulmonary disease (COPD) has a pulse
oximetry reading of 88% on room air. The nurse administers oxygen at 2 L/min via
nasal cannula. Which finding indicates that the oxygen therapy is having the
desired effect?
1. Respiratory rate increases from 22 to 28 breaths per minute
2. Oxygen saturation increases to 92%
Update – Advanced Medical-Surgical Nursing
Questions with Verified Answers and Elaborated
Solutions Academic Year
Q1. A client who has been receiving radiation therapy for bladder cancer tells the
nurse that it feels as if she is voiding through the vagina. The nurse interprets that
the client may be experiencing which condition?
1. Rupture of the bladder
2. The development of a vesicovaginal fistula
3. Extreme stress caused by the diagnosis of cancer
4. Altered perineal sensation as a side effect of radiation therapy
Rationale: A vesicovaginal fistula is a genital fistula that occurs between the
bladder and vagina. The fistula is an abnormal opening between these two body
parts and, if this occurs, the client may experience drainage of urine through the
vagina. The client's complaint is not associated with options 1, 3, or 4.
Q2. The nurse is teaching a client about the risk factors associated with colorectal
cancer. The nurse determines that further teaching is necessary related to colorectal
cancer if the client identifies which item as an associated risk factor?
1. Age younger than 50 years
2. History of colorectal polyps
3. Family history of colorectal cancer
4. Chronic inflammatory bowel disease
Rationale: Risk factors for colorectal cancer include age older than 50 years, a
history of colorectal polyps, a family history of colorectal cancer, and chronic
inflammatory bowel disease. Identifying age younger than 50 years as a risk factor
indicates a need for further teaching.
,Q3. The nurse is reviewing the record of a client with a diagnosis of cirrhosis and
notes that there is documentation of the presence of asterixis. How should the
nurse assess for its presence?
1. Dorsiflex the client's foot
2. Measure the abdominal girth
3. Ask the client to extend the arms
4. Instruct the client to lean forward
Rationale: Asterixis is irregular flapping movements of the fingers and wrists
when the hands and arms are outstretched, with the palms down, wrists bent up,
and fingers spread. Asterixis is the most common and reliable sign that hepatic
encephalopathy is developing. Options 1, 2, and 4 are incorrect.
Q4. The nurse is reviewing the laboratory results for a client with cirrhosis and
notes that the ammonia level is 85 mcg/dL (51 mmol/L). Which dietary selection
does the nurse suggest to the client?
1. Roast pork
2. Cheese omelet
3. Pasta with sauce
4. Tuna fish sandwich
Rationale: Cirrhosis is a chronic, progressive disease of the liver characterized by
diffuse degeneration and destruction of hepatocytes. The serum ammonia level
assesses the ability of the liver to deaminate protein byproducts. Normal reference
interval is 10 to 80 mcg/dL (6 to 47 mmol/L). Most of the ammonia in the body is
found in the gastrointestinal tract. Protein provided by the diet is transported to the
liver by the portal vein. The liver breaks down protein, which results in the
formation of ammonia. Foods high in protein should be avoided since the client's
ammonia level is elevated above the normal range; therefore, pasta with sauce
(lower in protein) would be the best selection.
, Q5. The nurse is reviewing a client's record and notes that the health care provider
has documented that the client has chronic renal disease. On review of the
laboratory results, the nurse most likely would expect to note which finding?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
4. Increased number of white blood cells in the urine
Rationale: The creatinine level is the most specific laboratory test to determine
renal function. The creatinine level increases when at least 50% of renal function is
lost. A decreased hemoglobin level and red blood cell count are associated with
anemia or blood loss and not specifically with decreased renal function. Increased
white blood cells in the urine indicate a urinary tract infection.
Q6. A client with heart failure is prescribed furosemide. Which laboratory value
should the nurse monitor most closely?
1. Serum sodium
2. Serum potassium
3. Serum calcium
4. Serum magnesium
Rationale: Furosemide is a loop diuretic that causes excretion of potassium.
Hypokalemia can lead to cardiac dysrhythmias. While sodium, calcium, and
magnesium may also be affected, potassium imbalance is the most common and
dangerous adverse effect.
Q7. A client with chronic obstructive pulmonary disease (COPD) has a pulse
oximetry reading of 88% on room air. The nurse administers oxygen at 2 L/min via
nasal cannula. Which finding indicates that the oxygen therapy is having the
desired effect?
1. Respiratory rate increases from 22 to 28 breaths per minute
2. Oxygen saturation increases to 92%
