NUR201 | NUR201 Medical Surgical Exam 3
Version 1 Questions with Correct Answers and
Expert Explanation for Each Question
1. A patient with cirrhosis is experiencing hepatic encephalopathy. Which laboratory
value should the nurse prioritize when monitoring the patient’s neurological status?
A. Serum Potassium
B. Serum Ammonia
C. Serum Creatinine
D. Serum Amylase
Correct Answer: B
Expert Explanation: Serum ammonia levels are elevated in patients with cirrhosis
because the liver is unable to convert ammonia into urea for excretion. High levels
of ammonia cross the blood-brain barrier and cause significant neurological
changes, including confusion and asterixis. Monitoring this value is crucial to
assessing the severity of hepatic encephalopathy and the effectiveness of treatments
like lactulose. While other labs are important for overall health, ammonia is the
primary neurotoxin involved in this specific complication. Nurses must report rising
levels immediately to prevent progression to hepatic coma.
,2. The nurse is caring for a patient admitted with acute pancreatitis. Which dietary
order should the nurse expect to implement first during the acute phase?
A. High-protein, low-fat diet
B. Nothing by mouth (NPO)
C. Clear liquid diet
D. Enteral feedings via nasogastric tube
Correct Answer: B
Expert Explanation: Maintaining NPO status is the priority intervention to rest the
pancreas and minimize the secretion of digestive enzymes. Pancreatic enzyme
secretion is stimulated by the presence of food in the stomach and duodenum,
which can worsen inflammation and pain. Intravenous fluids are typically
administered to maintain hydration and electrolyte balance while the patient is
fasting. Once the pain subsides and laboratory values improve, the diet can be
slowly advanced starting with liquids. This management strategy aims to reduce the
autodigestion of the pancreas and prevent further complications.
3. A patient with a suspected peptic ulcer reports sudden, severe abdominal pain that
radiates to the shoulder. What is the nurse’s priority action?
A. Notify the healthcare provider immediately
B. Check the patient’s blood pressure and pulse
,C. Assess the patient’s bowel sounds
D. Administer an antacid
Correct Answer: A
Expert Explanation: Sudden and severe pain radiating to the shoulder is a classic
sign of peptic ulcer perforation leading to peritonitis. Perforation is a medical
emergency that requires immediate surgical consultation and intervention to
prevent sepsis. The nurse must notify the provider and the surgical team to prepare
for potential emergency repair. While vital signs are important, the priority is
initiating the emergency response for a life-threatening complication. Early
recognition and rapid escalation of care significantly improve patient outcomes in
perforation cases.
4. Which assessment finding would the nurse expect to observe in a patient with
Crohn’s disease?
A. Continuous inflammation of the rectal mucosa
B. Uniform narrowing of the intestinal lumen
C. Bloody stools limited only to the colon
D. Steatorrhea and malabsorption
Correct Answer: D
, Expert Explanation: Crohn’s disease often affects the small intestine, leading to
malabsorption of fats and nutrients, which manifests as steatorrhea. Unlike
ulcerative colitis, Crohn’s is characterized by ‘skip lesions’ and can occur anywhere
along the gastrointestinal tract. The transmural nature of the inflammation can lead
to complications such as fistulas and strictures. Nurses should monitor the patient’s
nutritional status and weight due to frequent diarrhea and impaired absorption.
Understanding these physiological differences is essential for providing targeted
care and education to the patient.
5. A patient with portal hypertension is prescribed propranolol. The nurse
understands that this medication is used for which purpose in this patient?
A. To lower blood pressure and reduce the risk of variceal bleeding
B. To increase cardiac output and improve liver perfusion
C. To promote the excretion of excess fluid from ascites
D. To treat underlying cardiac dysrhythmias
Correct Answer: A
Expert Explanation: Nonselective beta-blockers like propranolol are used in
patients with cirrhosis to reduce portal venous pressure. By decreasing the pressure
in the portal system, the risk of developing or rupturing esophageal varices is
significantly lowered. This is a primary prevention strategy to avoid life-threatening
Version 1 Questions with Correct Answers and
Expert Explanation for Each Question
1. A patient with cirrhosis is experiencing hepatic encephalopathy. Which laboratory
value should the nurse prioritize when monitoring the patient’s neurological status?
A. Serum Potassium
B. Serum Ammonia
C. Serum Creatinine
D. Serum Amylase
Correct Answer: B
Expert Explanation: Serum ammonia levels are elevated in patients with cirrhosis
because the liver is unable to convert ammonia into urea for excretion. High levels
of ammonia cross the blood-brain barrier and cause significant neurological
changes, including confusion and asterixis. Monitoring this value is crucial to
assessing the severity of hepatic encephalopathy and the effectiveness of treatments
like lactulose. While other labs are important for overall health, ammonia is the
primary neurotoxin involved in this specific complication. Nurses must report rising
levels immediately to prevent progression to hepatic coma.
,2. The nurse is caring for a patient admitted with acute pancreatitis. Which dietary
order should the nurse expect to implement first during the acute phase?
A. High-protein, low-fat diet
B. Nothing by mouth (NPO)
C. Clear liquid diet
D. Enteral feedings via nasogastric tube
Correct Answer: B
Expert Explanation: Maintaining NPO status is the priority intervention to rest the
pancreas and minimize the secretion of digestive enzymes. Pancreatic enzyme
secretion is stimulated by the presence of food in the stomach and duodenum,
which can worsen inflammation and pain. Intravenous fluids are typically
administered to maintain hydration and electrolyte balance while the patient is
fasting. Once the pain subsides and laboratory values improve, the diet can be
slowly advanced starting with liquids. This management strategy aims to reduce the
autodigestion of the pancreas and prevent further complications.
3. A patient with a suspected peptic ulcer reports sudden, severe abdominal pain that
radiates to the shoulder. What is the nurse’s priority action?
A. Notify the healthcare provider immediately
B. Check the patient’s blood pressure and pulse
,C. Assess the patient’s bowel sounds
D. Administer an antacid
Correct Answer: A
Expert Explanation: Sudden and severe pain radiating to the shoulder is a classic
sign of peptic ulcer perforation leading to peritonitis. Perforation is a medical
emergency that requires immediate surgical consultation and intervention to
prevent sepsis. The nurse must notify the provider and the surgical team to prepare
for potential emergency repair. While vital signs are important, the priority is
initiating the emergency response for a life-threatening complication. Early
recognition and rapid escalation of care significantly improve patient outcomes in
perforation cases.
4. Which assessment finding would the nurse expect to observe in a patient with
Crohn’s disease?
A. Continuous inflammation of the rectal mucosa
B. Uniform narrowing of the intestinal lumen
C. Bloody stools limited only to the colon
D. Steatorrhea and malabsorption
Correct Answer: D
, Expert Explanation: Crohn’s disease often affects the small intestine, leading to
malabsorption of fats and nutrients, which manifests as steatorrhea. Unlike
ulcerative colitis, Crohn’s is characterized by ‘skip lesions’ and can occur anywhere
along the gastrointestinal tract. The transmural nature of the inflammation can lead
to complications such as fistulas and strictures. Nurses should monitor the patient’s
nutritional status and weight due to frequent diarrhea and impaired absorption.
Understanding these physiological differences is essential for providing targeted
care and education to the patient.
5. A patient with portal hypertension is prescribed propranolol. The nurse
understands that this medication is used for which purpose in this patient?
A. To lower blood pressure and reduce the risk of variceal bleeding
B. To increase cardiac output and improve liver perfusion
C. To promote the excretion of excess fluid from ascites
D. To treat underlying cardiac dysrhythmias
Correct Answer: A
Expert Explanation: Nonselective beta-blockers like propranolol are used in
patients with cirrhosis to reduce portal venous pressure. By decreasing the pressure
in the portal system, the risk of developing or rupturing esophageal varices is
significantly lowered. This is a primary prevention strategy to avoid life-threatening
