NU189 | NU 189 Medical-Surgical Nursing II
Midterm v2 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A client with a history of cirrhosis is admitted with suspected hepatic
encephalopathy. The nurse notes an increased ammonia level. Which medication
should the nurse expect to administer to decrease ammonia levels?
A. Lactulose
B. Spironolactone
C. Furosemide
D. Propranolol
Correct Answer: A
Expert Explanation: Lactulose is the primary medication used to treat hepatic
encephalopathy by promoting the excretion of ammonia through the stool. It works
by creating an acidic environment in the bowel that converts ammonia into
ammonium, which is not absorbable. The nurse should monitor the client for
increased frequency of bowel movements as an indicator of effectiveness.
2. A nurse is caring for a client who is 4 hours postoperative following a subtotal
thyroidectomy. Which finding should the nurse report to the provider immediately?
A. Pain at the incision site
,B. Laryngeal stridor
C. Hoarseness while speaking
D. Occasional coughing
Correct Answer: B
Expert Explanation: Laryngeal stridor is a high-pitched sound heard on inspiration
that indicates acute airway obstruction. This is a medical emergency that can be
caused by edema or tetany from hypocalcemia after thyroid surgery. The nurse
should have a tracheostomy kit available at the bedside for immediate use.
3. A client presents to the emergency department with signs of an acute ischemic
stroke. What is the priority assessment for the nurse to perform before administering
tissue plasminogen activator (tPA)?
A. Family history of heart disease
B. Current weight in kilograms
C. Last meal consumed
D. Time of symptom onset
Correct Answer: D
Expert Explanation: The time of symptom onset is the most critical assessment
because tPA must be administered within a specific window, usually 3 to 4.5 hours
,after the stroke starts. If the time of onset is unknown or outside this window, the
risk of intracranial hemorrhage outweighs the benefits. The nurse must also verify
that the client has a confirmed ischemic stroke via CT scan before therapy.
4. The nurse is evaluating the laboratory results for a client with Chronic Kidney
Disease (CKD). Which result is the most significant indicator of declining renal
function?
A. Decreased Hemoglobin
B. Increased Serum Sodium
C. Elevated Serum Creatinine
D. Decreased Blood Urea Nitrogen (BUN)
Correct Answer: C
Expert Explanation: Serum creatinine is the most reliable indicator of kidney
function because it is a waste product of muscle metabolism excreted solely by the
kidneys. While BUN can be affected by protein intake and hydration status,
creatinine levels are more stable indicators of the glomerular filtration rate. A rising
creatinine level indicates that the kidneys are unable to filter waste effectively.
5. A client with type 1 diabetes mellitus is found unconscious and clammy. What is the
first action the nurse should take?
A. Give a subcutaneous injection of glucagon
, B. Administer 15g of simple carbohydrates
C. Check the blood glucose level
D. Administer a regular insulin bolus
Correct Answer: A
Expert Explanation: In an unconscious client with suspected hypoglycemia,
providing oral carbohydrates is unsafe due to the risk of aspiration. Glucagon is the
emergency treatment of choice to rapidly increase blood glucose levels by
stimulating the liver to release stored glucose. Once the client regains
consciousness, a snack containing protein and complex carbohydrates should be
provided.
6. A nurse is assessing a client with Cushing’s syndrome. Which clinical manifestation
is commonly associated with this condition?
A. Pendulous abdomen and thin extremities
B. Hyperpigmentation of the skin
C. Hypotension and weight loss
D. Tachycardia and tremors
Correct Answer: A
Midterm v2 | Questions with Correct Answers and
Expert Explanation for Each Question | Galen
1. A client with a history of cirrhosis is admitted with suspected hepatic
encephalopathy. The nurse notes an increased ammonia level. Which medication
should the nurse expect to administer to decrease ammonia levels?
A. Lactulose
B. Spironolactone
C. Furosemide
D. Propranolol
Correct Answer: A
Expert Explanation: Lactulose is the primary medication used to treat hepatic
encephalopathy by promoting the excretion of ammonia through the stool. It works
by creating an acidic environment in the bowel that converts ammonia into
ammonium, which is not absorbable. The nurse should monitor the client for
increased frequency of bowel movements as an indicator of effectiveness.
2. A nurse is caring for a client who is 4 hours postoperative following a subtotal
thyroidectomy. Which finding should the nurse report to the provider immediately?
A. Pain at the incision site
,B. Laryngeal stridor
C. Hoarseness while speaking
D. Occasional coughing
Correct Answer: B
Expert Explanation: Laryngeal stridor is a high-pitched sound heard on inspiration
that indicates acute airway obstruction. This is a medical emergency that can be
caused by edema or tetany from hypocalcemia after thyroid surgery. The nurse
should have a tracheostomy kit available at the bedside for immediate use.
3. A client presents to the emergency department with signs of an acute ischemic
stroke. What is the priority assessment for the nurse to perform before administering
tissue plasminogen activator (tPA)?
A. Family history of heart disease
B. Current weight in kilograms
C. Last meal consumed
D. Time of symptom onset
Correct Answer: D
Expert Explanation: The time of symptom onset is the most critical assessment
because tPA must be administered within a specific window, usually 3 to 4.5 hours
,after the stroke starts. If the time of onset is unknown or outside this window, the
risk of intracranial hemorrhage outweighs the benefits. The nurse must also verify
that the client has a confirmed ischemic stroke via CT scan before therapy.
4. The nurse is evaluating the laboratory results for a client with Chronic Kidney
Disease (CKD). Which result is the most significant indicator of declining renal
function?
A. Decreased Hemoglobin
B. Increased Serum Sodium
C. Elevated Serum Creatinine
D. Decreased Blood Urea Nitrogen (BUN)
Correct Answer: C
Expert Explanation: Serum creatinine is the most reliable indicator of kidney
function because it is a waste product of muscle metabolism excreted solely by the
kidneys. While BUN can be affected by protein intake and hydration status,
creatinine levels are more stable indicators of the glomerular filtration rate. A rising
creatinine level indicates that the kidneys are unable to filter waste effectively.
5. A client with type 1 diabetes mellitus is found unconscious and clammy. What is the
first action the nurse should take?
A. Give a subcutaneous injection of glucagon
, B. Administer 15g of simple carbohydrates
C. Check the blood glucose level
D. Administer a regular insulin bolus
Correct Answer: A
Expert Explanation: In an unconscious client with suspected hypoglycemia,
providing oral carbohydrates is unsafe due to the risk of aspiration. Glucagon is the
emergency treatment of choice to rapidly increase blood glucose levels by
stimulating the liver to release stored glucose. Once the client regains
consciousness, a snack containing protein and complex carbohydrates should be
provided.
6. A nurse is assessing a client with Cushing’s syndrome. Which clinical manifestation
is commonly associated with this condition?
A. Pendulous abdomen and thin extremities
B. Hyperpigmentation of the skin
C. Hypotension and weight loss
D. Tachycardia and tremors
Correct Answer: A
