Exam 3: NUR 209 Medical-Surgical Nursing II
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Gastrointestinal, Hepatic Failure, Multi-Organ Dysfunction, & Acute Endocrine
Metabolic Crises
Q1: A patient with cirrhosis exhibits asterixis and worsening confusion. Which pathophysiology
explains these neurologic findings?
A. Decreased bile salt production
B. Portal vein thrombosis
C. Hepatorenal syndrome
D. Accumulation of ammonia crossing the blood-brain barrier
Correct Answer: D
Rationale: Hepatic encephalopathy results from the liver's inability to convert ammonia to urea,
allowing ammonia to accumulate in the bloodstream and cross the blood-brain barrier. Ammonia
disrupts neuronal function and causes cerebral edema, producing the characteristic asterixis and
altered mental status. Correct because toxic ammonia accumulation is the central
pathophysiologic mechanism underlying hepatic encephalopathy.
Q2: A 22-year-old patient with Type 1 diabetes presents with blood glucose 380 mg/dL, arterial
pH 7.28, and positive serum ketones. Which condition is present?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Thyroid storm
D. Adrenal crisis
Correct Answer: A
,Rationale: Diabetic ketoacidosis is characterized by absolute insulin deficiency leading to
hyperglycemia, ketone production, and metabolic acidosis with a pH below 7.30. The presence
of positive serum ketones in a patient with Type 1 diabetes confirms ketogenesis resulting from
uncontrolled lipolysis. Correct because the triad of hyperglycemia, ketonemia, and metabolic
acidosis defines diabetic ketoacidosis.
Q3: A patient with Graves disease presents with temperature 40.5°C, heart rate 156 beats per
minute, and severe agitation after missing antithyroid medication doses. Which condition is
present?
A. Myxedema coma
B. Adrenal crisis
C. Thyroid storm
D. Hepatic encephalopathy
Correct Answer: C
Rationale: Thyroid storm is a life-threatening exacerbation of hyperthyroidism characterized by
extreme hyperpyrexia, tachycardia, and neurologic dysfunction. Medication withdrawal is a
recognized precipitating trigger that allows uncontrolled thyroid hormone activity to produce
systemic decompensation. Correct because the combination of severe fever, extreme tachycardia,
and agitation in a patient with Graves disease is diagnostic of thyroid storm.
Q4: A patient with septic shock develops progressive respiratory failure followed by acute
kidney injury and coagulopathy. Which syndrome is evolving?
A. Cushing syndrome
B. Multi-organ dysfunction syndrome
C. Systemic lupus erythematosus
D. Addison disease
Correct Answer: B
Rationale: Multi-organ dysfunction syndrome is defined as the progressive failure of two or
more distinct organ systems, most commonly triggered by untreated septic shock. The sequence
of pulmonary failure followed by renal and hematologic dysfunction reflects the typical pattern
of organ involvement in MODS. Correct because the progressive failure of multiple organ
systems defines MODS.
, Q5: A patient with decompensated cirrhosis exhibits worsening mental status. Which findings
are consistent with hepatic encephalopathy? Select all that apply.
A. Bradycardia and hypotension
B. Asterixis with wrist extension
C. Fetor hepaticus on exhalation
D. Hypertension and bounding pulses
E. Confusion and disorientation
Correct Answer: B, C, E
Rationale: Asterixis is the hallmark flapping tremor observed when the patient extends the
wrists, resulting from ammonia-induced neuronal dysfunction. Fetor hepaticus is a musty sweet
breath odor caused by volatile mercaptans that accumulate when the liver fails to detoxify gut-
derived substances. Confusion and disorientation reflect early cerebral edema and
neurotransmitter imbalance caused by ammonia crossing the blood-brain barrier. Correct because
these three findings are classic clinical manifestations of hepatic encephalopathy.
Q6: A patient with diabetic ketoacidosis has a serum potassium of 3.1 mEq/L. Which
intervention must occur before initiating intravenous insulin?
A. Potassium repletion to above 3.3 mEq/L
B. Immediate insulin bolus regardless of potassium
C. Administration of sodium bicarbonate
D. Initiation of oral potassium supplements only
Correct Answer: A
Rationale: Insulin drives potassium intracellularly, which can precipitate life-threatening
hypokalemia and cardiac arrest if the serum potassium is below 3.3 mEq/L at the time of
administration. Current DKA protocols mandate potassium repletion before insulin initiation
when the serum potassium is in the critical low range. Correct because preventing fatal
hypokalemia takes precedence over glucose reduction in the initial DKA management phase.
Q7: A patient with cirrhosis and portal hypertension develops abdominal distension and shifting
dullness on percussion. Which complication is present?
A. Hepatic encephalopathy
B. Coagulopathy
C. Hepatorenal syndrome
D. Ascites
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Gastrointestinal, Hepatic Failure, Multi-Organ Dysfunction, & Acute Endocrine
Metabolic Crises
Q1: A patient with cirrhosis exhibits asterixis and worsening confusion. Which pathophysiology
explains these neurologic findings?
A. Decreased bile salt production
B. Portal vein thrombosis
C. Hepatorenal syndrome
D. Accumulation of ammonia crossing the blood-brain barrier
Correct Answer: D
Rationale: Hepatic encephalopathy results from the liver's inability to convert ammonia to urea,
allowing ammonia to accumulate in the bloodstream and cross the blood-brain barrier. Ammonia
disrupts neuronal function and causes cerebral edema, producing the characteristic asterixis and
altered mental status. Correct because toxic ammonia accumulation is the central
pathophysiologic mechanism underlying hepatic encephalopathy.
Q2: A 22-year-old patient with Type 1 diabetes presents with blood glucose 380 mg/dL, arterial
pH 7.28, and positive serum ketones. Which condition is present?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Thyroid storm
D. Adrenal crisis
Correct Answer: A
,Rationale: Diabetic ketoacidosis is characterized by absolute insulin deficiency leading to
hyperglycemia, ketone production, and metabolic acidosis with a pH below 7.30. The presence
of positive serum ketones in a patient with Type 1 diabetes confirms ketogenesis resulting from
uncontrolled lipolysis. Correct because the triad of hyperglycemia, ketonemia, and metabolic
acidosis defines diabetic ketoacidosis.
Q3: A patient with Graves disease presents with temperature 40.5°C, heart rate 156 beats per
minute, and severe agitation after missing antithyroid medication doses. Which condition is
present?
A. Myxedema coma
B. Adrenal crisis
C. Thyroid storm
D. Hepatic encephalopathy
Correct Answer: C
Rationale: Thyroid storm is a life-threatening exacerbation of hyperthyroidism characterized by
extreme hyperpyrexia, tachycardia, and neurologic dysfunction. Medication withdrawal is a
recognized precipitating trigger that allows uncontrolled thyroid hormone activity to produce
systemic decompensation. Correct because the combination of severe fever, extreme tachycardia,
and agitation in a patient with Graves disease is diagnostic of thyroid storm.
Q4: A patient with septic shock develops progressive respiratory failure followed by acute
kidney injury and coagulopathy. Which syndrome is evolving?
A. Cushing syndrome
B. Multi-organ dysfunction syndrome
C. Systemic lupus erythematosus
D. Addison disease
Correct Answer: B
Rationale: Multi-organ dysfunction syndrome is defined as the progressive failure of two or
more distinct organ systems, most commonly triggered by untreated septic shock. The sequence
of pulmonary failure followed by renal and hematologic dysfunction reflects the typical pattern
of organ involvement in MODS. Correct because the progressive failure of multiple organ
systems defines MODS.
, Q5: A patient with decompensated cirrhosis exhibits worsening mental status. Which findings
are consistent with hepatic encephalopathy? Select all that apply.
A. Bradycardia and hypotension
B. Asterixis with wrist extension
C. Fetor hepaticus on exhalation
D. Hypertension and bounding pulses
E. Confusion and disorientation
Correct Answer: B, C, E
Rationale: Asterixis is the hallmark flapping tremor observed when the patient extends the
wrists, resulting from ammonia-induced neuronal dysfunction. Fetor hepaticus is a musty sweet
breath odor caused by volatile mercaptans that accumulate when the liver fails to detoxify gut-
derived substances. Confusion and disorientation reflect early cerebral edema and
neurotransmitter imbalance caused by ammonia crossing the blood-brain barrier. Correct because
these three findings are classic clinical manifestations of hepatic encephalopathy.
Q6: A patient with diabetic ketoacidosis has a serum potassium of 3.1 mEq/L. Which
intervention must occur before initiating intravenous insulin?
A. Potassium repletion to above 3.3 mEq/L
B. Immediate insulin bolus regardless of potassium
C. Administration of sodium bicarbonate
D. Initiation of oral potassium supplements only
Correct Answer: A
Rationale: Insulin drives potassium intracellularly, which can precipitate life-threatening
hypokalemia and cardiac arrest if the serum potassium is below 3.3 mEq/L at the time of
administration. Current DKA protocols mandate potassium repletion before insulin initiation
when the serum potassium is in the critical low range. Correct because preventing fatal
hypokalemia takes precedence over glucose reduction in the initial DKA management phase.
Q7: A patient with cirrhosis and portal hypertension develops abdominal distension and shifting
dullness on percussion. Which complication is present?
A. Hepatic encephalopathy
B. Coagulopathy
C. Hepatorenal syndrome
D. Ascites
