NSG320 EXAM 4: ADVANCED ADULT
HEALTH NURSING QUESTIONS AND
ANSWERS
1. A patient with liver cirrhosis and hepatic encephalopathy is prescribed lactulose. What is
the primary therapeutic effect the nurse should monitor for?
A. Decrease in portal vein pressure and ascites
B. Promotion of potassium retention in the distal tubules
C. Reduction of serum ammonia levels through increased bowel movements
D. Enhancement of protein synthesis in the liver
Answer: C
Conceptual Explanation: Lactulose works by acidifying the colon contents, which
converts ammonia into ammonium, a non-absorbable form that is then excreted in the
stool.
2. Which assessment finding in a patient with acute pancreatitis requires immediate
notification of the provider?
A. Hyperactive bowel sounds in all four quadrants
,B. Serum amylase level three times the normal limit
C. Report of severe epigastric pain radiating to the back
D. Grey Turner’s sign (bluish discoloration of the flanks)
Answer: D
Conceptual Explanation: Grey Turner’s sign indicates retroperitoneal hemorrhage, a
severe complication of necrotizing pancreatitis that can lead to shock.
3. A patient is admitted with an Addisonian crisis. Which nursing intervention is the highest
priority?
A. Administering rapid intravenous fluid resuscitation and hydrocortisone
B. Teaching the patient about lifelong hormone replacement therapy
C. Monitoring for signs of hypernatremia and fluid volume excess
D. Checking the blood glucose level every 4 hours for hyperglycemia
Answer: A
Conceptual Explanation: Addisonian crisis is a life-threatening emergency characterized
by hypotension and vascular collapse; immediate fluid and steroid replacement are critical.
4. The nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a serum
potassium level of 6.8 mEq/L. Which medication should the nurse prepare to administer first
to protect the heart?
A. Furosemide IV push
, B. Sodium polystyrene sulfonate orally
C. Regular insulin and Dextrose 50% IV
D. Calcium gluconate IV
Answer: D
Conceptual Explanation: Calcium gluconate does not lower potassium but stabilizes the
myocardial cell membrane to prevent lethal arrhythmias caused by hyperkalemia.
5. A patient with a traumatic brain injury (TBI) has a Glascow Coma Scale (GCS) score of 7.
What is the nurse’s priority action?
A. Assess the patient’s pupillary response to light
B. Prepare for endotracheal intubation
C. Administer a bolus of intravenous mannitol
D. Position the patient in a side-lying position
Answer: B
Conceptual Explanation: A GCS score of 8 or less generally indicates a coma and the
inability to maintain a patent airway; intubation is required for airway protection.
6. Which clinical manifestation is most characteristic of Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)?
A. Severe dehydration and weight loss
B. Polyuria and increased serum osmolality
HEALTH NURSING QUESTIONS AND
ANSWERS
1. A patient with liver cirrhosis and hepatic encephalopathy is prescribed lactulose. What is
the primary therapeutic effect the nurse should monitor for?
A. Decrease in portal vein pressure and ascites
B. Promotion of potassium retention in the distal tubules
C. Reduction of serum ammonia levels through increased bowel movements
D. Enhancement of protein synthesis in the liver
Answer: C
Conceptual Explanation: Lactulose works by acidifying the colon contents, which
converts ammonia into ammonium, a non-absorbable form that is then excreted in the
stool.
2. Which assessment finding in a patient with acute pancreatitis requires immediate
notification of the provider?
A. Hyperactive bowel sounds in all four quadrants
,B. Serum amylase level three times the normal limit
C. Report of severe epigastric pain radiating to the back
D. Grey Turner’s sign (bluish discoloration of the flanks)
Answer: D
Conceptual Explanation: Grey Turner’s sign indicates retroperitoneal hemorrhage, a
severe complication of necrotizing pancreatitis that can lead to shock.
3. A patient is admitted with an Addisonian crisis. Which nursing intervention is the highest
priority?
A. Administering rapid intravenous fluid resuscitation and hydrocortisone
B. Teaching the patient about lifelong hormone replacement therapy
C. Monitoring for signs of hypernatremia and fluid volume excess
D. Checking the blood glucose level every 4 hours for hyperglycemia
Answer: A
Conceptual Explanation: Addisonian crisis is a life-threatening emergency characterized
by hypotension and vascular collapse; immediate fluid and steroid replacement are critical.
4. The nurse is caring for a patient with Chronic Kidney Disease (CKD) who has a serum
potassium level of 6.8 mEq/L. Which medication should the nurse prepare to administer first
to protect the heart?
A. Furosemide IV push
, B. Sodium polystyrene sulfonate orally
C. Regular insulin and Dextrose 50% IV
D. Calcium gluconate IV
Answer: D
Conceptual Explanation: Calcium gluconate does not lower potassium but stabilizes the
myocardial cell membrane to prevent lethal arrhythmias caused by hyperkalemia.
5. A patient with a traumatic brain injury (TBI) has a Glascow Coma Scale (GCS) score of 7.
What is the nurse’s priority action?
A. Assess the patient’s pupillary response to light
B. Prepare for endotracheal intubation
C. Administer a bolus of intravenous mannitol
D. Position the patient in a side-lying position
Answer: B
Conceptual Explanation: A GCS score of 8 or less generally indicates a coma and the
inability to maintain a patent airway; intubation is required for airway protection.
6. Which clinical manifestation is most characteristic of Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)?
A. Severe dehydration and weight loss
B. Polyuria and increased serum osmolality
