NSG 3850 EXAM 4 GALEN COLLEGE OF
NURSING NEWEST AND UPGRADED
VERSION WITH GUARANTEED PASS/
2025/2026
1. A patient with a known history of alcoholism presents with massive
hematemesis and profound anemia. The ER nurse suspects which of the
following diagnosis to be the most likely cause?
• A. Ascites
• B. Cerebral edema
• C. Hepatic encephalopathy
• D. Gastroesophageal varices
Rationale: Portal hypertension from cirrhosis causes blood to back up
into the vessels of the esophagus and stomach, leading to the formation
of varices. These vessels are fragile and prone to rupture, resulting in life-
threatening hematemesis.
2. A patient admitted with a bleeding peptic ulcer is likely to receive a
continuous IV infusion of which medication?
• A. Glucose
• B. Octreotide acetate
• C. Anticoagulants
• D. Proton pump inhibitors
,Rationale: Octreotide is a synthetic analog of the hormone somatostatin.
It reduces splanchnic blood flow and portal pressure, helping to control
acute variceal and non-variceal upper GI bleeding.
3. A patient with cirrhosis is disoriented and lethargic, with asterixis.
Which dietary modification is the priority?
• A. Low-protein
• B. High-protein
• C. High-sodium
• D. Unrestricted
Rationale: The patient is displaying signs of hepatic encephalopathy,
which is often precipitated by a high-protein diet. Ammonia, a byproduct
of protein metabolism, is not effectively cleared by a failing liver, leading
to neurological symptoms. A temporary low-protein diet is initiated.
4. A patient who has sustained a severe traumatic brain injury has
increasing intracranial pressure (ICP) that is unresponsive to standard
interventions. The nurse anticipates the administration of:
• A. Varices (worsening).
• B. Encephalopathy (worsening).
• C. Peritonitis.
• D. Cerebral edema.
Rationale: Mannitol is an osmotic diuretic that pulls fluid from the brain
tissue into the vascular space, reducing cerebral edema and lowering
ICP. The physician will likely order mannitol for this patient.
,5. A 28-year-old female has an autoimmune disorder that primarily
affects her skin, kidneys, and joints, and her labs show the presence of
autoantibodies (ANA). Which condition is this most consistent with?
• A. Rheumatoid arthritis
• B. Systemic lupus erythematosus (SLE)
• C. Multiple sclerosis
• D. Goodpasture syndrome
Rationale: SLE is a systemic autoimmune disease characterized by the
production of autoantibodies (including ANA) and can affect almost any
organ system, including the skin, kidneys, and joints.
6. A nurse is reviewing the lab results of a patient with chronic kidney
disease. The patient's hemoglobin is 8.5 g/dL. The nurse knows this is
most likely due to:
• A. Iron deficiency from poor diet.
• B. Destruction of RBCs by the immune system.
• C. A lack of intrinsic factor.
• D. Decreased production of erythropoietin by the kidneys.
Rationale: The kidneys produce erythropoietin (EPO), a hormone that
stimulates the bone marrow to produce red blood cells. In chronic
kidney disease, the damaged kidneys produce less EPO, leading to
anemia.
7. A patient being treated for chronic anemia notices a new symptom: a
strong desire to eat ice chips and clay. The nurse documents this finding
using which appropriate term?
• A. Pagophagia
, • B. Geophagia
• C. Aphasia
• D. Pica
Rationale: Pica is the term for a craving to eat non-nutritive substances
like ice, clay, or dirt. It is a common finding in iron deficiency anemia.
8. A patient is newly diagnosed with pernicious anemia. The nurse
understands that this condition results from the body's inability to:
• A. Metabolize iron properly.
• B. Absorb vitamin B12 from the GI tract.
• C. Produce enough intrinsic factor.
• D. Produce enough erythropoietin.
Rationale: Pernicious anemia is caused by a lack of intrinsic factor (IF), a
protein made by the stomach that is necessary for vitamin B12
absorption in the small intestine.
9. A patient's lab work shows a critically low platelet count. Which of the
following is a key distinction in the pathophysiology between Immune
Thrombocytopenia (ITP) and Thrombotic Thrombocytopenic Purpura
(TTP)?
• A. ITP is caused by a lack of vitamin K.
• B. TTP is characterized by widespread microthrombi, while ITP
is an isolated low platelet count.
• C. ITP leads to excessive clotting, while TTP leads to bleeding.
• D. TTP is treated with platelet transfusions, while ITP is not.
Rationale: TTP is a rare disorder that causes clots to form in small blood
vessels, using up platelets and leading to a low count. In contrast, ITP is
NURSING NEWEST AND UPGRADED
VERSION WITH GUARANTEED PASS/
2025/2026
1. A patient with a known history of alcoholism presents with massive
hematemesis and profound anemia. The ER nurse suspects which of the
following diagnosis to be the most likely cause?
• A. Ascites
• B. Cerebral edema
• C. Hepatic encephalopathy
• D. Gastroesophageal varices
Rationale: Portal hypertension from cirrhosis causes blood to back up
into the vessels of the esophagus and stomach, leading to the formation
of varices. These vessels are fragile and prone to rupture, resulting in life-
threatening hematemesis.
2. A patient admitted with a bleeding peptic ulcer is likely to receive a
continuous IV infusion of which medication?
• A. Glucose
• B. Octreotide acetate
• C. Anticoagulants
• D. Proton pump inhibitors
,Rationale: Octreotide is a synthetic analog of the hormone somatostatin.
It reduces splanchnic blood flow and portal pressure, helping to control
acute variceal and non-variceal upper GI bleeding.
3. A patient with cirrhosis is disoriented and lethargic, with asterixis.
Which dietary modification is the priority?
• A. Low-protein
• B. High-protein
• C. High-sodium
• D. Unrestricted
Rationale: The patient is displaying signs of hepatic encephalopathy,
which is often precipitated by a high-protein diet. Ammonia, a byproduct
of protein metabolism, is not effectively cleared by a failing liver, leading
to neurological symptoms. A temporary low-protein diet is initiated.
4. A patient who has sustained a severe traumatic brain injury has
increasing intracranial pressure (ICP) that is unresponsive to standard
interventions. The nurse anticipates the administration of:
• A. Varices (worsening).
• B. Encephalopathy (worsening).
• C. Peritonitis.
• D. Cerebral edema.
Rationale: Mannitol is an osmotic diuretic that pulls fluid from the brain
tissue into the vascular space, reducing cerebral edema and lowering
ICP. The physician will likely order mannitol for this patient.
,5. A 28-year-old female has an autoimmune disorder that primarily
affects her skin, kidneys, and joints, and her labs show the presence of
autoantibodies (ANA). Which condition is this most consistent with?
• A. Rheumatoid arthritis
• B. Systemic lupus erythematosus (SLE)
• C. Multiple sclerosis
• D. Goodpasture syndrome
Rationale: SLE is a systemic autoimmune disease characterized by the
production of autoantibodies (including ANA) and can affect almost any
organ system, including the skin, kidneys, and joints.
6. A nurse is reviewing the lab results of a patient with chronic kidney
disease. The patient's hemoglobin is 8.5 g/dL. The nurse knows this is
most likely due to:
• A. Iron deficiency from poor diet.
• B. Destruction of RBCs by the immune system.
• C. A lack of intrinsic factor.
• D. Decreased production of erythropoietin by the kidneys.
Rationale: The kidneys produce erythropoietin (EPO), a hormone that
stimulates the bone marrow to produce red blood cells. In chronic
kidney disease, the damaged kidneys produce less EPO, leading to
anemia.
7. A patient being treated for chronic anemia notices a new symptom: a
strong desire to eat ice chips and clay. The nurse documents this finding
using which appropriate term?
• A. Pagophagia
, • B. Geophagia
• C. Aphasia
• D. Pica
Rationale: Pica is the term for a craving to eat non-nutritive substances
like ice, clay, or dirt. It is a common finding in iron deficiency anemia.
8. A patient is newly diagnosed with pernicious anemia. The nurse
understands that this condition results from the body's inability to:
• A. Metabolize iron properly.
• B. Absorb vitamin B12 from the GI tract.
• C. Produce enough intrinsic factor.
• D. Produce enough erythropoietin.
Rationale: Pernicious anemia is caused by a lack of intrinsic factor (IF), a
protein made by the stomach that is necessary for vitamin B12
absorption in the small intestine.
9. A patient's lab work shows a critically low platelet count. Which of the
following is a key distinction in the pathophysiology between Immune
Thrombocytopenia (ITP) and Thrombotic Thrombocytopenic Purpura
(TTP)?
• A. ITP is caused by a lack of vitamin K.
• B. TTP is characterized by widespread microthrombi, while ITP
is an isolated low platelet count.
• C. ITP leads to excessive clotting, while TTP leads to bleeding.
• D. TTP is treated with platelet transfusions, while ITP is not.
Rationale: TTP is a rare disorder that causes clots to form in small blood
vessels, using up platelets and leading to a low count. In contrast, ITP is
