Brunner & Suddarth's Medical-Surgical
Nursing Advanced Prep: Master Nursing
Practice & Pathophysiology Practice
Questions & Detailed Explanations
Subject: Medical-Surgical Nursing (Chapters 1-68)
Question 1: A patient with severe acute pancreatitis is being monitored for systemic
complications. The nurse notes the patient’s respiratory rate has increased to 28 breaths/minute,
arterial oxygen saturation ($SaO_2$) is 88% on room air, and the patient reports increasing
dyspnea. Given the pathophysiology of acute pancreatitis, what is the most likely etiology of
these findings?
A) The patient is developing aspiration pneumonia due to a decreased level of consciousness.
B) The release of phospholipase A2 and free fatty acids into the circulation is causing damage to
the alveolar-capillary membrane, leading to ARDS.
C) The patient has developed a pleural effusion secondary to fluid overload from over-aggressive
resuscitation.
D) The patient’s diaphragm is being compressed by severe abdominal ascites.
Correct Answer: B) The release of phospholipase A2 and free fatty acids into the circulation
is causing damage to the alveolar-capillary membrane, leading to ARDS.
Explanation: Acute pancreatitis is characterized by the systemic release of activated pancreatic
enzymes. Phospholipase A2 is particularly cytotoxic; it destroys the integrity of the alveolar-
capillary membrane, leading to capillary leak, pulmonary edema, and acute respiratory distress
syndrome (ARDS), which is a common and life-threatening systemic complication.
Question 2: A client is admitted with suspected Pheochromocytoma. Which intervention should
the nurse prioritize to prevent a hypertensive crisis during the diagnostic assessment?
A) Ensure the patient performs a 24-hour urine collection for fractionated metanephrines.
B) Administer a prophylactic dose of a beta-blocker before any physical examination of the
abdomen.
C) Maintain a quiet environment and avoid palpating the abdomen.
,D) Administer a high-sodium diet to stabilize fluid volume.
Correct Answer: C) Maintain a quiet environment and avoid palpating the abdomen.
Explanation: Pheochromocytoma is a catecholamine-secreting tumor. Palpation of the abdomen
can stimulate the tumor to release a massive surge of catecholamines, precipitating a life-
threatening hypertensive crisis. Beta-blockers should never be given before alpha-adrenergic
blockade, as doing so can lead to unopposed alpha-mediated vasoconstriction.
Question 3: A 62-year-old patient with cirrhosis presents with confusion, asterixis, and a serum
ammonia level of 110 mcg/dL. The nurse administers lactulose as prescribed. Which finding
indicates the medication is achieving its intended therapeutic goal?
A) The patient has two soft, formed stools daily.
B) The patient experiences an increase in appetite.
C) The patient has three to four loose stools per day and demonstrates improved orientation.
D) The patient's serum albumin level begins to rise.
Correct Answer: C) The patient has three to four loose stools per day and demonstrates
improved orientation.
Explanation: Lactulose works by acidifying the gut, converting ammonia ($NH_3$) to
ammonium ($NH_4^+$), which cannot be absorbed. The osmotic laxative effect ensures the
trapped ammonium is excreted. Achieving 3-4 stools daily is the standard clinical endpoint for
effective ammonia clearance and resolution of hepatic encephalopathy symptoms.
Question 4: A nurse is caring for a patient following a total thyroidectomy. The patient develops
tingling in the lips and fingertips and a positive Trousseau’s sign. What is the nurse's priority
action?
A) Administer intravenous (IV) potassium chloride.
B) Prepare for the administration of IV calcium gluconate.
C) Increase the rate of the maintenance IV fluids.
D) Assess the patient’s airway and prepare for re-intubation.
Correct Answer: B) Prepare for the administration of IV calcium gluconate.
Explanation: Post-thyroidectomy complications include accidental damage or removal of the
parathyroid glands, leading to acute hypocalcemia. Tingling (paresthesia) and a positive
,Trousseau’s sign indicate neuromuscular irritability due to low calcium. IV calcium gluconate is
the standard corrective treatment.
Question 5: A client with newly diagnosed Addison’s disease is receiving corticosteroid
replacement therapy. What instruction is most important for the nurse to provide regarding
medication adherence?
A) "Take your medication only when you feel fatigued."
B) "Never stop taking the medication abruptly, as this can precipitate an adrenal crisis."
C) "Increase your dose during periods of extreme calm to prevent hypertension."
D) "Take the medication on an empty stomach to increase absorption."
Correct Answer: B) "Never stop taking the medication abruptly, as this can precipitate an
adrenal crisis."
Explanation: In Addison’s disease, the adrenal glands do not produce sufficient corticosteroids.
Abrupt cessation of replacement therapy leads to acute adrenal insufficiency (adrenal crisis),
which is characterized by profound hypotension and circulatory collapse.
Question 6: A patient with heart failure is prescribed spironolactone. What specific lab value
must the nurse monitor to identify a potentially dangerous side effect?
A) Serum sodium
B) Serum potassium
C) Serum magnesium
D) Blood glucose
Correct Answer: B) Serum potassium
Explanation: Spironolactone is a potassium-sparing diuretic. It inhibits the action of aldosterone
in the distal tubule, leading to sodium excretion but potassium retention. Monitoring for
hyperkalemia is essential to prevent cardiac arrhythmias.
Question 7: A client with chronic kidney disease (CKD) is prescribed epoetin alfa. What is the
expected outcome of this therapy?
A) Decreased risk of uremic frost.
B) Increased production of red blood cells to treat anemia.
, C) Lowering of serum phosphorus levels.
D) Improved clearance of creatinine.
Correct Answer: B) Increased production of red blood cells to treat anemia.
Explanation: In CKD, the kidneys fail to produce adequate erythropoietin, the hormone that
stimulates bone marrow to produce RBCs. Epoetin alfa is a synthetic erythropoietin substitute
used to correct anemia.
Question 8: A patient is undergoing plasmapheresis for the treatment of Myasthenia Gravis.
What clinical manifestation should the nurse monitor for closely as a result of the procedure?
A) Hyperkalemia
B) Hypocalcemia
C) Fluid overload
D) Metabolic alkalosis
Correct Answer: B) Hypocalcemia
Explanation: Citrate is used as an anticoagulant during plasmapheresis to prevent blood from
clotting in the machine. Citrate binds to calcium in the patient's blood, leading to hypocalcemia
(manifesting as paresthesia or tetany).
Question 9: Which arterial blood gas (ABG) result would the nurse expect in a client with
prolonged vomiting?
A) pH 7.30, $PaCO_2$ 50 mmHg, $HCO_3$ 24 mEq/L
B) pH 7.50, $PaCO_2$ 45 mmHg, $HCO_3$ 32 mEq/L
C) pH 7.25, $PaCO_2$ 35 mmHg, $HCO_3$ 18 mEq/L
D) pH 7.45, $PaCO_2$ 40 mmHg, $HCO_3$ 24 mEq/L
Correct Answer: B) pH 7.50, $PaCO_2$ 45 mmHg, $HCO_3$ 32 mEq/L
Explanation: Vomiting results in the loss of gastric hydrochloric acid (HCl), leading to metabolic
alkalosis (elevated pH and elevated bicarbonate). Option B reflects uncompensated metabolic
alkalosis.
Question 10: In a patient with increased intracranial pressure (ICP), why is hyperventilation
sometimes used as a temporary emergency measure?
Nursing Advanced Prep: Master Nursing
Practice & Pathophysiology Practice
Questions & Detailed Explanations
Subject: Medical-Surgical Nursing (Chapters 1-68)
Question 1: A patient with severe acute pancreatitis is being monitored for systemic
complications. The nurse notes the patient’s respiratory rate has increased to 28 breaths/minute,
arterial oxygen saturation ($SaO_2$) is 88% on room air, and the patient reports increasing
dyspnea. Given the pathophysiology of acute pancreatitis, what is the most likely etiology of
these findings?
A) The patient is developing aspiration pneumonia due to a decreased level of consciousness.
B) The release of phospholipase A2 and free fatty acids into the circulation is causing damage to
the alveolar-capillary membrane, leading to ARDS.
C) The patient has developed a pleural effusion secondary to fluid overload from over-aggressive
resuscitation.
D) The patient’s diaphragm is being compressed by severe abdominal ascites.
Correct Answer: B) The release of phospholipase A2 and free fatty acids into the circulation
is causing damage to the alveolar-capillary membrane, leading to ARDS.
Explanation: Acute pancreatitis is characterized by the systemic release of activated pancreatic
enzymes. Phospholipase A2 is particularly cytotoxic; it destroys the integrity of the alveolar-
capillary membrane, leading to capillary leak, pulmonary edema, and acute respiratory distress
syndrome (ARDS), which is a common and life-threatening systemic complication.
Question 2: A client is admitted with suspected Pheochromocytoma. Which intervention should
the nurse prioritize to prevent a hypertensive crisis during the diagnostic assessment?
A) Ensure the patient performs a 24-hour urine collection for fractionated metanephrines.
B) Administer a prophylactic dose of a beta-blocker before any physical examination of the
abdomen.
C) Maintain a quiet environment and avoid palpating the abdomen.
,D) Administer a high-sodium diet to stabilize fluid volume.
Correct Answer: C) Maintain a quiet environment and avoid palpating the abdomen.
Explanation: Pheochromocytoma is a catecholamine-secreting tumor. Palpation of the abdomen
can stimulate the tumor to release a massive surge of catecholamines, precipitating a life-
threatening hypertensive crisis. Beta-blockers should never be given before alpha-adrenergic
blockade, as doing so can lead to unopposed alpha-mediated vasoconstriction.
Question 3: A 62-year-old patient with cirrhosis presents with confusion, asterixis, and a serum
ammonia level of 110 mcg/dL. The nurse administers lactulose as prescribed. Which finding
indicates the medication is achieving its intended therapeutic goal?
A) The patient has two soft, formed stools daily.
B) The patient experiences an increase in appetite.
C) The patient has three to four loose stools per day and demonstrates improved orientation.
D) The patient's serum albumin level begins to rise.
Correct Answer: C) The patient has three to four loose stools per day and demonstrates
improved orientation.
Explanation: Lactulose works by acidifying the gut, converting ammonia ($NH_3$) to
ammonium ($NH_4^+$), which cannot be absorbed. The osmotic laxative effect ensures the
trapped ammonium is excreted. Achieving 3-4 stools daily is the standard clinical endpoint for
effective ammonia clearance and resolution of hepatic encephalopathy symptoms.
Question 4: A nurse is caring for a patient following a total thyroidectomy. The patient develops
tingling in the lips and fingertips and a positive Trousseau’s sign. What is the nurse's priority
action?
A) Administer intravenous (IV) potassium chloride.
B) Prepare for the administration of IV calcium gluconate.
C) Increase the rate of the maintenance IV fluids.
D) Assess the patient’s airway and prepare for re-intubation.
Correct Answer: B) Prepare for the administration of IV calcium gluconate.
Explanation: Post-thyroidectomy complications include accidental damage or removal of the
parathyroid glands, leading to acute hypocalcemia. Tingling (paresthesia) and a positive
,Trousseau’s sign indicate neuromuscular irritability due to low calcium. IV calcium gluconate is
the standard corrective treatment.
Question 5: A client with newly diagnosed Addison’s disease is receiving corticosteroid
replacement therapy. What instruction is most important for the nurse to provide regarding
medication adherence?
A) "Take your medication only when you feel fatigued."
B) "Never stop taking the medication abruptly, as this can precipitate an adrenal crisis."
C) "Increase your dose during periods of extreme calm to prevent hypertension."
D) "Take the medication on an empty stomach to increase absorption."
Correct Answer: B) "Never stop taking the medication abruptly, as this can precipitate an
adrenal crisis."
Explanation: In Addison’s disease, the adrenal glands do not produce sufficient corticosteroids.
Abrupt cessation of replacement therapy leads to acute adrenal insufficiency (adrenal crisis),
which is characterized by profound hypotension and circulatory collapse.
Question 6: A patient with heart failure is prescribed spironolactone. What specific lab value
must the nurse monitor to identify a potentially dangerous side effect?
A) Serum sodium
B) Serum potassium
C) Serum magnesium
D) Blood glucose
Correct Answer: B) Serum potassium
Explanation: Spironolactone is a potassium-sparing diuretic. It inhibits the action of aldosterone
in the distal tubule, leading to sodium excretion but potassium retention. Monitoring for
hyperkalemia is essential to prevent cardiac arrhythmias.
Question 7: A client with chronic kidney disease (CKD) is prescribed epoetin alfa. What is the
expected outcome of this therapy?
A) Decreased risk of uremic frost.
B) Increased production of red blood cells to treat anemia.
, C) Lowering of serum phosphorus levels.
D) Improved clearance of creatinine.
Correct Answer: B) Increased production of red blood cells to treat anemia.
Explanation: In CKD, the kidneys fail to produce adequate erythropoietin, the hormone that
stimulates bone marrow to produce RBCs. Epoetin alfa is a synthetic erythropoietin substitute
used to correct anemia.
Question 8: A patient is undergoing plasmapheresis for the treatment of Myasthenia Gravis.
What clinical manifestation should the nurse monitor for closely as a result of the procedure?
A) Hyperkalemia
B) Hypocalcemia
C) Fluid overload
D) Metabolic alkalosis
Correct Answer: B) Hypocalcemia
Explanation: Citrate is used as an anticoagulant during plasmapheresis to prevent blood from
clotting in the machine. Citrate binds to calcium in the patient's blood, leading to hypocalcemia
(manifesting as paresthesia or tetany).
Question 9: Which arterial blood gas (ABG) result would the nurse expect in a client with
prolonged vomiting?
A) pH 7.30, $PaCO_2$ 50 mmHg, $HCO_3$ 24 mEq/L
B) pH 7.50, $PaCO_2$ 45 mmHg, $HCO_3$ 32 mEq/L
C) pH 7.25, $PaCO_2$ 35 mmHg, $HCO_3$ 18 mEq/L
D) pH 7.45, $PaCO_2$ 40 mmHg, $HCO_3$ 24 mEq/L
Correct Answer: B) pH 7.50, $PaCO_2$ 45 mmHg, $HCO_3$ 32 mEq/L
Explanation: Vomiting results in the loss of gastric hydrochloric acid (HCl), leading to metabolic
alkalosis (elevated pH and elevated bicarbonate). Option B reflects uncompensated metabolic
alkalosis.
Question 10: In a patient with increased intracranial pressure (ICP), why is hyperventilation
sometimes used as a temporary emergency measure?
