1
NUR210 / NUR 210 Exam 2 – Principles of Pharmacology \
MED/SURG 2 - Test 1 | 75 NCLEX-Style Practice Questions \
Liver Disease | Hepatitis | Pancreatitis | Osteoporosis | Sickle
Cell Anemia | Malabsorption | Pyloric Stenosis
SECTION 1: LIVER DISEASE & CIRRHOSIS
Question 1. A client with cirrhosis develops ascites and is prescribed
spironolactone. Which laboratory value is most important for the nurse to
monitor?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER : B
Rationale: Spironolactone is a potassium-sparing diuretic that blocks aldosterone
receptors. The primary risk is hyperkalemia. Serum potassium must be closely
monitored, especially in clients with cirrhosis who may already have renal
impairment. Sodium (A) may be monitored but is not the primary concern with
spironolactone.
Question 2. A nurse is assessing a client with advanced cirrhosis. Which finding
indicates the presence of hepatic encephalopathy?
A. Caput medusae
B. Spider angiomas
C. Asterixis (flapping tremor)
D. Palmar erythema
CORRECT ANSWER : C
Rationale: Asterixis, a coarse flapping tremor when the wrists are extended, is a
classic sign of hepatic encephalopathy caused by accumulation of ammonia and
other neurotoxins. Caput medusae (A), spider angiomas (B), and palmar erythema
pg. 1
,2
(D) are cutaneous signs of chronic liver disease but do not indicate
encephalopathy.
Question 3. A client with cirrhosis develops hematemesis. What is the priority
nursing action?
A. Administer an oral antacid
B. Assess vital signs and prepare for IV access and fluid resuscitation
C. Place the client in Trendelenburg position
D. Encourage clear liquids
CORRECT ANSWER : B
Rationale: Hematemesis in cirrhosis indicates variceal bleeding, a life-threatening
emergency. The priority is assessment of hemodynamic stability (vital signs) and
establishing large-bore IV access for fluid resuscitation and possible blood
transfusion. Antacids (A) are useless. Trendelenburg (C) increases aspiration risk.
Oral intake (D) is contraindicated.
Question 4. Lactulose is prescribed for a client with hepatic encephalopathy. The
nurse understands this medication works by:
A. Decreasing intestinal absorption of ammonia
B. Acidifying the colon, which converts ammonia (NH₃) to ammonium (NH₄⁺),
trapping it for excretion
C. Increasing ammonia production
D. Neutralizing gastric acid
CORRECT ANSWER : B
Rationale: Lactulose is a non-absorbable disaccharide that is metabolized by
colonic bacteria, lowering colonic pH. This acidification converts ammonia (NH₃),
which diffuses freely into the blood, to ammonium ions (NH₄⁺), which cannot
cross the intestinal barrier and are excreted in stool. It does not decrease
absorption (A) but traps ammonia.
pg. 2
,3
Question 5. A client with cirrhosis is at increased risk for bleeding because:
A. The spleen produces too many platelets
B. The liver synthesizes clotting factors, and impaired function leads to
decreased production of factors II, VII, IX, X
C. Vitamin K levels are elevated
D. The bone marrow is suppressed
CORRECT ANSWER : B
Rationale: The liver produces most clotting factors, including the vitamin K-
dependent factors (II, VII, IX, X). Cirrhosis impairs synthetic function, leading to
coagulopathy and prolonged PT/INR. Vitamin K (C) is often deficient, not elevated.
Platelets may be decreased due to splenic sequestration, not increased (A).
Question 6. A client with ascites is scheduled for paracentesis. Which nursing
action is essential before the procedure?
A. Encourage a high-fiber meal
B. Instruct the client to empty the bladder
C. Place the client in a prone position
D. Administer a sedative
CORRECT ANSWER : B
Rationale: Emptying the bladder before paracentesis reduces the risk of
accidental bladder puncture during needle insertion. The client is positioned
upright or semi-Fowler's, not prone (C). High-fiber meals (A) are not required.
Sedation (D) is not routine.
Question 7. A client with cirrhosis has a serum albumin of 2.0 g/dL. This finding is
primarily due to:
A. Increased albumin breakdown in the gut
B. Decreased hepatic synthesis of albumin
C. Excessive renal excretion
D. Dietary protein deficiency alone
pg. 3
, 4
CORRECT ANSWER : B
Rationale: Albumin is synthesized exclusively by the liver. In cirrhosis, hepatocyte
damage and loss of functional tissue reduce albumin production, leading to
hypoalbuminemia. This contributes to ascites formation by decreasing plasma
oncotic pressure.
Question 8. A client with cirrhosis develops confusion and a flapping tremor.
Which serum lab value best correlates with this condition?
A. Elevated bilirubin
B. Elevated ALT/AST
C. Elevated ammonia
D. Decreased albumin
CORRECT ANSWER : C
Rationale: Hepatic encephalopathy is primarily caused by elevated serum
ammonia levels, which result from the liver's inability to convert ammonia to
urea. Neurotoxic effects of ammonia cause confusion, asterixis, and coma.
Bilirubin (A) and liver enzymes (B) indicate hepatocellular injury but not
encephalopathy directly.
Question 9. Which dietary modification is appropriate for a client with cirrhosis
and ascites?
A. High-protein, unrestricted sodium
B. Moderate-protein, sodium-restricted diet (2 g/day)
C. High-fat, high-sodium diet
D. Protein-restricted, high-sodium diet
CORRECT ANSWER : B
Rationale: Sodium restriction (typically 2 g/day) is essential to manage ascites and
edema. Protein should be moderate (0.8-1.2 g/kg/day) to support hepatic
regeneration without precipitating encephalopathy. Fluid restriction may also be
needed if hyponatremia is present.
pg. 4
NUR210 / NUR 210 Exam 2 – Principles of Pharmacology \
MED/SURG 2 - Test 1 | 75 NCLEX-Style Practice Questions \
Liver Disease | Hepatitis | Pancreatitis | Osteoporosis | Sickle
Cell Anemia | Malabsorption | Pyloric Stenosis
SECTION 1: LIVER DISEASE & CIRRHOSIS
Question 1. A client with cirrhosis develops ascites and is prescribed
spironolactone. Which laboratory value is most important for the nurse to
monitor?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
CORRECT ANSWER : B
Rationale: Spironolactone is a potassium-sparing diuretic that blocks aldosterone
receptors. The primary risk is hyperkalemia. Serum potassium must be closely
monitored, especially in clients with cirrhosis who may already have renal
impairment. Sodium (A) may be monitored but is not the primary concern with
spironolactone.
Question 2. A nurse is assessing a client with advanced cirrhosis. Which finding
indicates the presence of hepatic encephalopathy?
A. Caput medusae
B. Spider angiomas
C. Asterixis (flapping tremor)
D. Palmar erythema
CORRECT ANSWER : C
Rationale: Asterixis, a coarse flapping tremor when the wrists are extended, is a
classic sign of hepatic encephalopathy caused by accumulation of ammonia and
other neurotoxins. Caput medusae (A), spider angiomas (B), and palmar erythema
pg. 1
,2
(D) are cutaneous signs of chronic liver disease but do not indicate
encephalopathy.
Question 3. A client with cirrhosis develops hematemesis. What is the priority
nursing action?
A. Administer an oral antacid
B. Assess vital signs and prepare for IV access and fluid resuscitation
C. Place the client in Trendelenburg position
D. Encourage clear liquids
CORRECT ANSWER : B
Rationale: Hematemesis in cirrhosis indicates variceal bleeding, a life-threatening
emergency. The priority is assessment of hemodynamic stability (vital signs) and
establishing large-bore IV access for fluid resuscitation and possible blood
transfusion. Antacids (A) are useless. Trendelenburg (C) increases aspiration risk.
Oral intake (D) is contraindicated.
Question 4. Lactulose is prescribed for a client with hepatic encephalopathy. The
nurse understands this medication works by:
A. Decreasing intestinal absorption of ammonia
B. Acidifying the colon, which converts ammonia (NH₃) to ammonium (NH₄⁺),
trapping it for excretion
C. Increasing ammonia production
D. Neutralizing gastric acid
CORRECT ANSWER : B
Rationale: Lactulose is a non-absorbable disaccharide that is metabolized by
colonic bacteria, lowering colonic pH. This acidification converts ammonia (NH₃),
which diffuses freely into the blood, to ammonium ions (NH₄⁺), which cannot
cross the intestinal barrier and are excreted in stool. It does not decrease
absorption (A) but traps ammonia.
pg. 2
,3
Question 5. A client with cirrhosis is at increased risk for bleeding because:
A. The spleen produces too many platelets
B. The liver synthesizes clotting factors, and impaired function leads to
decreased production of factors II, VII, IX, X
C. Vitamin K levels are elevated
D. The bone marrow is suppressed
CORRECT ANSWER : B
Rationale: The liver produces most clotting factors, including the vitamin K-
dependent factors (II, VII, IX, X). Cirrhosis impairs synthetic function, leading to
coagulopathy and prolonged PT/INR. Vitamin K (C) is often deficient, not elevated.
Platelets may be decreased due to splenic sequestration, not increased (A).
Question 6. A client with ascites is scheduled for paracentesis. Which nursing
action is essential before the procedure?
A. Encourage a high-fiber meal
B. Instruct the client to empty the bladder
C. Place the client in a prone position
D. Administer a sedative
CORRECT ANSWER : B
Rationale: Emptying the bladder before paracentesis reduces the risk of
accidental bladder puncture during needle insertion. The client is positioned
upright or semi-Fowler's, not prone (C). High-fiber meals (A) are not required.
Sedation (D) is not routine.
Question 7. A client with cirrhosis has a serum albumin of 2.0 g/dL. This finding is
primarily due to:
A. Increased albumin breakdown in the gut
B. Decreased hepatic synthesis of albumin
C. Excessive renal excretion
D. Dietary protein deficiency alone
pg. 3
, 4
CORRECT ANSWER : B
Rationale: Albumin is synthesized exclusively by the liver. In cirrhosis, hepatocyte
damage and loss of functional tissue reduce albumin production, leading to
hypoalbuminemia. This contributes to ascites formation by decreasing plasma
oncotic pressure.
Question 8. A client with cirrhosis develops confusion and a flapping tremor.
Which serum lab value best correlates with this condition?
A. Elevated bilirubin
B. Elevated ALT/AST
C. Elevated ammonia
D. Decreased albumin
CORRECT ANSWER : C
Rationale: Hepatic encephalopathy is primarily caused by elevated serum
ammonia levels, which result from the liver's inability to convert ammonia to
urea. Neurotoxic effects of ammonia cause confusion, asterixis, and coma.
Bilirubin (A) and liver enzymes (B) indicate hepatocellular injury but not
encephalopathy directly.
Question 9. Which dietary modification is appropriate for a client with cirrhosis
and ascites?
A. High-protein, unrestricted sodium
B. Moderate-protein, sodium-restricted diet (2 g/day)
C. High-fat, high-sodium diet
D. Protein-restricted, high-sodium diet
CORRECT ANSWER : B
Rationale: Sodium restriction (typically 2 g/day) is essential to manage ascites and
edema. Protein should be moderate (0.8-1.2 g/kg/day) to support hepatic
regeneration without precipitating encephalopathy. Fluid restriction may also be
needed if hyponatremia is present.
pg. 4
