NU 186 Exam 2 V3 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 2) | Galen
1. A client is admitted with a potassium level of 6.2 mEq/L. Which of the following findings
should the nurse expect to assess? (Select All That Apply)
A. Peaked T waves on the ECG
B. Hyperactive bowel sounds and diarrhea
C. Muscle weakness or paralysis
D. Hypotension and bradycardia
E. Prominent U waves on the ECG
F. Constipation and paralytic ileus
Correct Answer: A, B, C, D
Explanation; Hyperkalemia affects cardiac and neuromuscular function significantly.
Peaked T waves and widened QRS complexes are hallmark signs of high potassium levels
on an electrocardiogram. Gastrointestinal motility is typically increased, leading to
diarrhea, unlike hypokalemia which causes constipation.
2. A nurse is caring for a client with chronic kidney disease (CKD) who has a glomerular
filtration rate (GFR) of 25 mL/min. Which dietary intervention is most appropriate?
A. Increase protein intake to 1.5 g/kg/day
,B. Restrict dietary phosphorus intake
C. Encourage the use of salt substitutes
D. Maintain a high-potassium diet
Correct Answer: B
Explanation; In CKD stage 4, the kidneys cannot effectively excrete phosphorus, leading to
hyperphosphatemia and secondary hyperparathyroidism. Protein is usually restricted
rather than increased to reduce the buildup of nitrogenous waste. Salt substitutes should
be avoided because they often contain potassium, which can lead to life-threatening
hyperkalemia in CKD patients.
3. A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which
laboratory value is most specific to this diagnosis?
A. Serum Lipase
B. Serum Amylase
C. White Blood Cell (WBC) count
D. Serum Calcium
Correct Answer: A
Explanation; Serum lipase is more specific than amylase for diagnosing acute pancreatitis
because it stays elevated longer and is primarily produced by the pancreas. While amylase
rises early, it can also be elevated in other conditions such as mumps or intestinal
, obstruction. Hypocalcemia may occur in severe pancreatitis, but it is a prognostic indicator
rather than a primary diagnostic tool.
4. The nurse is assessing a client with cirrhosis and notes increased lethargy and a flapping
tremor of the hands (asterixis). Which medication does the nurse anticipate administering?
A. Spironolactone
B. Propranolol
C. Furosemide
D. Lactulose
Correct Answer: D
Explanation; Asterixis and lethargy are classic signs of hepatic encephalopathy caused by
high ammonia levels. Lactulose works by acidifying the colon and converting ammonia to
ammonium, which is then excreted in the stool. Effective treatment is evidenced by
increased bowel movements and improved neurological status.
5. A client is 12 hours postoperative following a subtotal gastrectomy. The nurse notes that
the nasogastric (NG) tube has stopped draining and the client reports abdominal distention.
What is the priority nursing action?
A. Notify the healthcare provider
B. Reposition the client to their side
C. Irrigate the NG tube with 30 mL of normal saline
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 2) | Galen
1. A client is admitted with a potassium level of 6.2 mEq/L. Which of the following findings
should the nurse expect to assess? (Select All That Apply)
A. Peaked T waves on the ECG
B. Hyperactive bowel sounds and diarrhea
C. Muscle weakness or paralysis
D. Hypotension and bradycardia
E. Prominent U waves on the ECG
F. Constipation and paralytic ileus
Correct Answer: A, B, C, D
Explanation; Hyperkalemia affects cardiac and neuromuscular function significantly.
Peaked T waves and widened QRS complexes are hallmark signs of high potassium levels
on an electrocardiogram. Gastrointestinal motility is typically increased, leading to
diarrhea, unlike hypokalemia which causes constipation.
2. A nurse is caring for a client with chronic kidney disease (CKD) who has a glomerular
filtration rate (GFR) of 25 mL/min. Which dietary intervention is most appropriate?
A. Increase protein intake to 1.5 g/kg/day
,B. Restrict dietary phosphorus intake
C. Encourage the use of salt substitutes
D. Maintain a high-potassium diet
Correct Answer: B
Explanation; In CKD stage 4, the kidneys cannot effectively excrete phosphorus, leading to
hyperphosphatemia and secondary hyperparathyroidism. Protein is usually restricted
rather than increased to reduce the buildup of nitrogenous waste. Salt substitutes should
be avoided because they often contain potassium, which can lead to life-threatening
hyperkalemia in CKD patients.
3. A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which
laboratory value is most specific to this diagnosis?
A. Serum Lipase
B. Serum Amylase
C. White Blood Cell (WBC) count
D. Serum Calcium
Correct Answer: A
Explanation; Serum lipase is more specific than amylase for diagnosing acute pancreatitis
because it stays elevated longer and is primarily produced by the pancreas. While amylase
rises early, it can also be elevated in other conditions such as mumps or intestinal
, obstruction. Hypocalcemia may occur in severe pancreatitis, but it is a prognostic indicator
rather than a primary diagnostic tool.
4. The nurse is assessing a client with cirrhosis and notes increased lethargy and a flapping
tremor of the hands (asterixis). Which medication does the nurse anticipate administering?
A. Spironolactone
B. Propranolol
C. Furosemide
D. Lactulose
Correct Answer: D
Explanation; Asterixis and lethargy are classic signs of hepatic encephalopathy caused by
high ammonia levels. Lactulose works by acidifying the colon and converting ammonia to
ammonium, which is then excreted in the stool. Effective treatment is evidenced by
increased bowel movements and improved neurological status.
5. A client is 12 hours postoperative following a subtotal gastrectomy. The nurse notes that
the nasogastric (NG) tube has stopped draining and the client reports abdominal distention.
What is the priority nursing action?
A. Notify the healthcare provider
B. Reposition the client to their side
C. Irrigate the NG tube with 30 mL of normal saline
