NSG 3800 Exam 4 V2 | NSG 3800 Nursing Practice – Adult Health II |
Actual Q&A with Rationale (NSG3800 Exam 4) | Galen
1. A nurse is caring for a patient who just underwent a liver biopsy. Which of the following
positions is most appropriate for the patient during the immediate post-operative period?
A. High-Fowler’s position to improve lung expansion.
B. Left side-lying to prevent pressure on the incision site.
C. Right side-lying to provide pressure to the biopsy site.
D. Supine with the head of the bed elevated 45 degrees.
Answer: C
Rationale: After a liver biopsy, the patient should be placed in a right side-lying position
for several hours. This position uses the patient’s own body weight to apply pressure to the
liver, which is highly vascular, to minimize the risk of bleeding. The nurse should also
monitor vital signs closely for signs of internal hemorrhage or shock during this time.
2. A patient with hepatic encephalopathy is prescribed lactulose. What is the primary
therapeutic effect the nurse should monitor for?
A. Increased urine output to reduce ascites.
B. Decrease in serum ammonia levels and improved mental status.
C. Reduced blood pressure via vasodilation.
D. Prevention of gastrointestinal bleeding from varices.
Answer: B
Rationale: Lactulose works by promoting the excretion of ammonia through the stool by
creating an acidic environment in the bowel. High ammonia levels are the primary cause of
neurological symptoms in hepatic encephalopathy, so a reduction indicates treatment
success. The nurse should assess the patient for increased orientation and a reduction in
asterixis as evidence of improvement.
3. The nurse is assessing a patient with acute pancreatitis. Which of the following laboratory
findings would the nurse expect to see?
A. Elevated serum amylase and lipase levels.
B. Increased serum calcium and decreased glucose.
C. Decreased serum lipase and amylase.
D. Increased hemoglobin and hematocrit.
,Answer: A
Rationale: In acute pancreatitis, the autodigestion of the pancreas leads to the release of
digestive enzymes into the bloodstream. Amylase usually rises within 24 hours and lipase
remains elevated for a longer duration, making them key diagnostic markers. The nurse
should also monitor for hypocalcemia and hyperglycemia which are common
complications of this condition.
4. Which clinical manifestation should the nurse prioritize when assessing a patient for a
potential fat embolism syndrome after a femur fracture?
A. Altered mental status and petechiae on the chest.
B. Decreased range of motion in the affected limb.
C. Localized swelling and redness at the fracture site.
D. Pain that is unrelieved by opioid analgesics.
Answer: A
Rationale: Fat embolism syndrome is a serious complication of long-bone fractures where
fat globules enter the bloodstream and lodge in the lungs or brain. The classic triad
includes respiratory distress, neurologic changes such as confusion, and a petechial rash on
the neck and chest. This is a medical emergency that requires immediate oxygenation and
notification of the healthcare provider.
5. A patient with chronic kidney disease (CKD) is receiving epoetin alfa. What is the primary
purpose of this medication?
A. To stimulate the production of red blood cells.
B. To lower serum potassium levels.
C. To increase the excretion of phosphorus.
D. To prevent the formation of renal calculi.
Answer: A
Rationale: In chronic kidney disease, the kidneys fail to produce sufficient erythropoietin,
leading to anemia. Epoetin alfa is a synthetic form of this hormone that stimulates the bone
marrow to produce red blood cells. The nurse should monitor the patient’s hemoglobin and
blood pressure, as hypertension is a common side effect of this therapy.
6. A nurse is providing discharge teaching to a patient with Addison’s disease. Which
instruction is most important to include regarding corticosteroid therapy?
A. Stop taking the medication if you experience weight gain.
B. Take the medication only on an empty stomach.
C. Increase the dose slightly when experiencing significant stress.
, D. Avoid all forms of exercise while taking the medication.
Answer: C
Rationale: Patients with Addison’s disease cannot produce enough cortisol to handle
physical or emotional stress, putting them at risk for an Addisonian crisis. They must be
taught to increase their steroid dosage during times of illness, surgery, or extreme stress as
directed by their provider. Failure to do so can lead to life-threatening hypotension and
vascular collapse.
7. A patient is diagnosed with Cushing’s syndrome. Which of the following physical
assessment findings is consistent with this diagnosis?
A. Hypotension and weight loss.
B. Bronze-colored skin and tremors.
C. Thin, brittle hair and a slow heart rate.
D. Moon face, buffalo hump, and truncal obesity.
Answer: D
Rationale: Cushing’s syndrome results from an excess of corticosteroids, particularly
glucocorticoids. This leads to a redistribution of fat to the face (moon face), the upper back
(buffalo hump), and the abdomen (truncal obesity). Other symptoms include purple striae,
thin skin, and easy bruising due to protein wasting.
8. The nurse is caring for a patient following a transurethral resection of the prostate (TURP).
The patient has a continuous bladder irrigation (CBI) system in place. Which finding requires
immediate intervention?
A. The drainage in the collection bag is light pink.
B. The output in the bag is significantly less than the amount of irrigant infused.
C. The patient reports a constant urge to void.
D. Small blood clots are visible in the drainage tubing.
Answer: B
Rationale: If the output is less than the intake from the irrigation, it indicates an
obstruction in the catheter, often caused by a large clot. This can lead to bladder distention,
pain, and potential rupture if not resolved quickly. The nurse should immediately assess
the patency of the tube and perform manual irrigation if ordered.
9. A patient with Type 1 Diabetes is admitted with Diabetic Ketoacidosis (DKA). Which of the
following arterial blood gas results would the nurse expect?
A. pH 7.20, PaCO2 55, HCO3 28.
B. pH 7.50, PaCO2 48, HCO3 30.
Actual Q&A with Rationale (NSG3800 Exam 4) | Galen
1. A nurse is caring for a patient who just underwent a liver biopsy. Which of the following
positions is most appropriate for the patient during the immediate post-operative period?
A. High-Fowler’s position to improve lung expansion.
B. Left side-lying to prevent pressure on the incision site.
C. Right side-lying to provide pressure to the biopsy site.
D. Supine with the head of the bed elevated 45 degrees.
Answer: C
Rationale: After a liver biopsy, the patient should be placed in a right side-lying position
for several hours. This position uses the patient’s own body weight to apply pressure to the
liver, which is highly vascular, to minimize the risk of bleeding. The nurse should also
monitor vital signs closely for signs of internal hemorrhage or shock during this time.
2. A patient with hepatic encephalopathy is prescribed lactulose. What is the primary
therapeutic effect the nurse should monitor for?
A. Increased urine output to reduce ascites.
B. Decrease in serum ammonia levels and improved mental status.
C. Reduced blood pressure via vasodilation.
D. Prevention of gastrointestinal bleeding from varices.
Answer: B
Rationale: Lactulose works by promoting the excretion of ammonia through the stool by
creating an acidic environment in the bowel. High ammonia levels are the primary cause of
neurological symptoms in hepatic encephalopathy, so a reduction indicates treatment
success. The nurse should assess the patient for increased orientation and a reduction in
asterixis as evidence of improvement.
3. The nurse is assessing a patient with acute pancreatitis. Which of the following laboratory
findings would the nurse expect to see?
A. Elevated serum amylase and lipase levels.
B. Increased serum calcium and decreased glucose.
C. Decreased serum lipase and amylase.
D. Increased hemoglobin and hematocrit.
,Answer: A
Rationale: In acute pancreatitis, the autodigestion of the pancreas leads to the release of
digestive enzymes into the bloodstream. Amylase usually rises within 24 hours and lipase
remains elevated for a longer duration, making them key diagnostic markers. The nurse
should also monitor for hypocalcemia and hyperglycemia which are common
complications of this condition.
4. Which clinical manifestation should the nurse prioritize when assessing a patient for a
potential fat embolism syndrome after a femur fracture?
A. Altered mental status and petechiae on the chest.
B. Decreased range of motion in the affected limb.
C. Localized swelling and redness at the fracture site.
D. Pain that is unrelieved by opioid analgesics.
Answer: A
Rationale: Fat embolism syndrome is a serious complication of long-bone fractures where
fat globules enter the bloodstream and lodge in the lungs or brain. The classic triad
includes respiratory distress, neurologic changes such as confusion, and a petechial rash on
the neck and chest. This is a medical emergency that requires immediate oxygenation and
notification of the healthcare provider.
5. A patient with chronic kidney disease (CKD) is receiving epoetin alfa. What is the primary
purpose of this medication?
A. To stimulate the production of red blood cells.
B. To lower serum potassium levels.
C. To increase the excretion of phosphorus.
D. To prevent the formation of renal calculi.
Answer: A
Rationale: In chronic kidney disease, the kidneys fail to produce sufficient erythropoietin,
leading to anemia. Epoetin alfa is a synthetic form of this hormone that stimulates the bone
marrow to produce red blood cells. The nurse should monitor the patient’s hemoglobin and
blood pressure, as hypertension is a common side effect of this therapy.
6. A nurse is providing discharge teaching to a patient with Addison’s disease. Which
instruction is most important to include regarding corticosteroid therapy?
A. Stop taking the medication if you experience weight gain.
B. Take the medication only on an empty stomach.
C. Increase the dose slightly when experiencing significant stress.
, D. Avoid all forms of exercise while taking the medication.
Answer: C
Rationale: Patients with Addison’s disease cannot produce enough cortisol to handle
physical or emotional stress, putting them at risk for an Addisonian crisis. They must be
taught to increase their steroid dosage during times of illness, surgery, or extreme stress as
directed by their provider. Failure to do so can lead to life-threatening hypotension and
vascular collapse.
7. A patient is diagnosed with Cushing’s syndrome. Which of the following physical
assessment findings is consistent with this diagnosis?
A. Hypotension and weight loss.
B. Bronze-colored skin and tremors.
C. Thin, brittle hair and a slow heart rate.
D. Moon face, buffalo hump, and truncal obesity.
Answer: D
Rationale: Cushing’s syndrome results from an excess of corticosteroids, particularly
glucocorticoids. This leads to a redistribution of fat to the face (moon face), the upper back
(buffalo hump), and the abdomen (truncal obesity). Other symptoms include purple striae,
thin skin, and easy bruising due to protein wasting.
8. The nurse is caring for a patient following a transurethral resection of the prostate (TURP).
The patient has a continuous bladder irrigation (CBI) system in place. Which finding requires
immediate intervention?
A. The drainage in the collection bag is light pink.
B. The output in the bag is significantly less than the amount of irrigant infused.
C. The patient reports a constant urge to void.
D. Small blood clots are visible in the drainage tubing.
Answer: B
Rationale: If the output is less than the intake from the irrigation, it indicates an
obstruction in the catheter, often caused by a large clot. This can lead to bladder distention,
pain, and potential rupture if not resolved quickly. The nurse should immediately assess
the patency of the tube and perform manual irrigation if ordered.
9. A patient with Type 1 Diabetes is admitted with Diabetic Ketoacidosis (DKA). Which of the
following arterial blood gas results would the nurse expect?
A. pH 7.20, PaCO2 55, HCO3 28.
B. pH 7.50, PaCO2 48, HCO3 30.
