NU 186 Exam 3 V3 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 3) | Galen
1. A nurse is caring for a client with end-stage renal disease (ESRD) who is scheduled for
hemodialysis. Which assessment finding is the most critical to report to the healthcare
provider immediately?
A. Blood pressure of 148/92 mmHg
B. A thrill felt over the arteriovenous (AV) fistula
C. Weight gain of 2 kg since the last treatment
D. Potassium level of 6.8 mEq/L
Correct Answer: D
Explanation; A potassium level of 6.8 mEq/L indicates severe hyperkalemia, which poses
an immediate risk for life-threatening cardiac arrhythmias. While weight gain and elevated
blood pressure are common in ESRD, they do not take precedence over electrolyte
imbalances that can cause cardiac arrest. A thrill over the AV fistula is a normal and
expected finding indicating patency.
2. A client is diagnosed with Acute Pancreatitis. Which of the following laboratory results
should the nurse expect to be elevated? Select all that apply.
A. Serum Amylase
,B. Serum Lipase
C. Serum Calcium
D. White Blood Cell (WBC) count
E. Blood Glucose
F. Serum Bilirubin
Correct Answer: A, B, D, E, F
Explanation; In acute pancreatitis, serum amylase and lipase are significantly elevated due
to pancreatic cell injury. The WBC count increases as a result of the inflammatory process,
and blood glucose rises because insulin production may be impaired. Serum calcium levels
typically decrease (hypocalcemia) rather than increase, while bilirubin may rise if the
biliary duct is obstructed.
3. A nurse is preparing to administer lactulose to a client with hepatic encephalopathy. What
is the primary therapeutic goal of this medication?
A. To provide a source of calories for a malnourished client.
B. To decrease serum ammonia levels through bowel evacuation.
C. To promote the excretion of excess bilirubin in the stool.
D. To acidify the stomach contents to prevent peptic ulcers.
Correct Answer: B
,Explanation; Lactulose is an osmotic laxative used in liver failure to reduce serum
ammonia levels by trapping ammonia in the gut and expelling it through feces. High
ammonia levels are the primary cause of neurological symptoms in hepatic
encephalopathy. Success of the therapy is measured by improved mental status and
increased frequency of soft stools.
4. The nurse is monitoring a client during the first hour of hemodialysis. The client complains
of a headache, nausea, and becomes increasingly confused. Which action should the nurse
take first?
A. Stop or slow the dialysis treatment.
B. Increase the blood flow rate to finish the treatment faster.
C. Assess the client’s blood pressure and contact the provider.
D. Administer an antiemetic for the nausea.
Correct Answer: A
Explanation; These symptoms are characteristic of dialysis disequilibrium syndrome,
caused by the rapid removal of solutes from the blood compared to the brain. The first
priority is to slow or stop the dialysis to prevent worsening cerebral edema. The nurse
should then notify the physician and monitor the client’s neurological status closely.
5. A client with cirrhosis is experiencing significant ascites. Which nursing intervention is most
important for maintaining respiratory function?
A. Perform abdominal girth measurements daily.
, B. Encourage the use of an incentive spirometer every 4 hours.
C. Place the client in a high-Fowler’s position.
D. Restrict fluid intake to 1000 mL per day.
Correct Answer: C
Explanation; Ascites increases intra-abdominal pressure, which pushes the diaphragm
upward and restricts lung expansion. Placing the client in a high-Fowler’s position uses
gravity to shift the abdominal fluid downward, allowing for better chest expansion. While
other interventions are relevant to cirrhosis care, positioning provides the most immediate
respiratory benefit.
6. The nurse is teaching a client with newly diagnosed Type 1 Diabetes about Sick Day
Management. Which statement by the client indicates a need for further teaching?
A. I will check my blood sugar every 4 hours while I am sick.
B. I will test my urine for ketones if my blood sugar is over 240 mg/dL.
C. I will stop taking my insulin if I am unable to eat solid food.
D. I will drink plenty of fluids to prevent dehydration.
Correct Answer: C
Explanation; Clients with Type 1 Diabetes must never stop taking insulin even when ill, as
the stress of illness increases blood glucose and the risk of Diabetic Ketoacidosis (DKA).
They should follow a protocol for supplemental insulin and consume liquid carbohydrates
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 3) | Galen
1. A nurse is caring for a client with end-stage renal disease (ESRD) who is scheduled for
hemodialysis. Which assessment finding is the most critical to report to the healthcare
provider immediately?
A. Blood pressure of 148/92 mmHg
B. A thrill felt over the arteriovenous (AV) fistula
C. Weight gain of 2 kg since the last treatment
D. Potassium level of 6.8 mEq/L
Correct Answer: D
Explanation; A potassium level of 6.8 mEq/L indicates severe hyperkalemia, which poses
an immediate risk for life-threatening cardiac arrhythmias. While weight gain and elevated
blood pressure are common in ESRD, they do not take precedence over electrolyte
imbalances that can cause cardiac arrest. A thrill over the AV fistula is a normal and
expected finding indicating patency.
2. A client is diagnosed with Acute Pancreatitis. Which of the following laboratory results
should the nurse expect to be elevated? Select all that apply.
A. Serum Amylase
,B. Serum Lipase
C. Serum Calcium
D. White Blood Cell (WBC) count
E. Blood Glucose
F. Serum Bilirubin
Correct Answer: A, B, D, E, F
Explanation; In acute pancreatitis, serum amylase and lipase are significantly elevated due
to pancreatic cell injury. The WBC count increases as a result of the inflammatory process,
and blood glucose rises because insulin production may be impaired. Serum calcium levels
typically decrease (hypocalcemia) rather than increase, while bilirubin may rise if the
biliary duct is obstructed.
3. A nurse is preparing to administer lactulose to a client with hepatic encephalopathy. What
is the primary therapeutic goal of this medication?
A. To provide a source of calories for a malnourished client.
B. To decrease serum ammonia levels through bowel evacuation.
C. To promote the excretion of excess bilirubin in the stool.
D. To acidify the stomach contents to prevent peptic ulcers.
Correct Answer: B
,Explanation; Lactulose is an osmotic laxative used in liver failure to reduce serum
ammonia levels by trapping ammonia in the gut and expelling it through feces. High
ammonia levels are the primary cause of neurological symptoms in hepatic
encephalopathy. Success of the therapy is measured by improved mental status and
increased frequency of soft stools.
4. The nurse is monitoring a client during the first hour of hemodialysis. The client complains
of a headache, nausea, and becomes increasingly confused. Which action should the nurse
take first?
A. Stop or slow the dialysis treatment.
B. Increase the blood flow rate to finish the treatment faster.
C. Assess the client’s blood pressure and contact the provider.
D. Administer an antiemetic for the nausea.
Correct Answer: A
Explanation; These symptoms are characteristic of dialysis disequilibrium syndrome,
caused by the rapid removal of solutes from the blood compared to the brain. The first
priority is to slow or stop the dialysis to prevent worsening cerebral edema. The nurse
should then notify the physician and monitor the client’s neurological status closely.
5. A client with cirrhosis is experiencing significant ascites. Which nursing intervention is most
important for maintaining respiratory function?
A. Perform abdominal girth measurements daily.
, B. Encourage the use of an incentive spirometer every 4 hours.
C. Place the client in a high-Fowler’s position.
D. Restrict fluid intake to 1000 mL per day.
Correct Answer: C
Explanation; Ascites increases intra-abdominal pressure, which pushes the diaphragm
upward and restricts lung expansion. Placing the client in a high-Fowler’s position uses
gravity to shift the abdominal fluid downward, allowing for better chest expansion. While
other interventions are relevant to cirrhosis care, positioning provides the most immediate
respiratory benefit.
6. The nurse is teaching a client with newly diagnosed Type 1 Diabetes about Sick Day
Management. Which statement by the client indicates a need for further teaching?
A. I will check my blood sugar every 4 hours while I am sick.
B. I will test my urine for ketones if my blood sugar is over 240 mg/dL.
C. I will stop taking my insulin if I am unable to eat solid food.
D. I will drink plenty of fluids to prevent dehydration.
Correct Answer: C
Explanation; Clients with Type 1 Diabetes must never stop taking insulin even when ill, as
the stress of illness increases blood glucose and the risk of Diabetic Ketoacidosis (DKA).
They should follow a protocol for supplemental insulin and consume liquid carbohydrates
