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Exam 4 Final NSG 3800 Med Surg II Exam
Questions and Answers Practice Questions with
Solutions Newest | Already Graded A+
Practice Exam Questions (NCLEX-Style)
Test your knowledge with these questions. The correct answer is highlighted, followed by a detailed
rationale.
1. A nurse is visiting a client who has hypothyroidism and has been taking levothyroxine for 3 weeks.
It is a priority for the nurse to follow up if the client says what?
• A. "I still feel so tired all the time."
• B. "I haven't had a bowel movement in 2 days."
• C. "Sometimes my heart feels like it is racing and I get dizzy."
• D. "My skin is still dry and my hair is brittle."
Rationale: This statement indicates possible overmedication (hyperthyroidism symptoms), which can
lead to serious cardiac complications like tachycardia and arrhythmias. The priority is to prevent a
thyroid storm.
2. A nurse is caring for a patient diagnosed with adrenocortical deficiency (Addison's disease). The
nurse teaches the client about a new prescription for hydrocortisone. Which statement by the client
indicates an understanding of a key adverse effect?
• A. "I will need to avoid eating foods high in potassium."
• B. "I know this medication can make it harder for my body to fight off infections."
• C. "I should stop taking this medication if I start to feel better."
• D. "This medication will help me lose weight."
Rationale: Hydrocortisone is a corticosteroid, which causes immunosuppression, increasing the risk for
infection. Clients should be taught to report any signs of infection immediately.
3. A nurse is assessing a client who is 4 hours post-operative following a thyroidectomy. The client is
demonstrating spasms of the arm when a blood pressure cuff is inflated. The nurse should prepare to
immediately administer which of the following IV medications?
• A. Potassium Chloride
• B. Calcium Gluconate
,2
• C. Magnesium Sulfate
• D. Regular Insulin
Rationale: This positive Trousseau's sign indicates hypocalcemia due to accidental removal or damage of
the parathyroid glands during surgery. The priority treatment is IV calcium to prevent life-threatening
tetany and laryngeal spasms.
4. The nurse is admitting a client who is at risk for myxedema coma. Which of the following
interventions should the nurse include as a priority in the client's care plan?
• A. Initiate a fluid restriction to 1L per day.
• B. Avoid the use of hypnotic and sedative medications.
• C. Keep the client in a supine position.
• D. Administer oral thyroid replacement immediately.
Rationale: Clients with myxedema coma have a very low metabolic rate and are extremely sensitive to
central nervous system depressants. Sedatives can lead to respiratory depression and worsening coma.
5. A nurse is assessing a client who has hyperthyroidism and is at risk for developing a thyroid storm.
It is necessary for the nurse to notify the PCP if the client exhibits which of the following?
• A. A blood pressure of 110/70 mm Hg.
• B. A report of mild fatigue.
• C. Extreme tachycardia with a heart rate of 140 bpm.
• D. A low-grade fever of 99.5°F (37.5°C).
Rationale: Extreme tachycardia is a hallmark sign of thyroid storm, a life-threatening exacerbation of
hyperthyroidism. Other signs include high fever, delirium, and severe GI distress.
6. A patient came to the ED and was symptomatic for a small bowel obstruction. What should the
nurse do next?
• A. Administer a tap water enema.
• B. Prepare to insert an NG tube to decompress the bowel.
• C. Offer the patient small, frequent sips of water.
• D. Prepare the patient for an immediate colonoscopy.
Rationale: The priority for a bowel obstruction is to place the patient on NPO status and insert an NG
tube for gastric decompression to relieve pressure and prevent vomiting and aspiration.
7. A nurse is assessing a patient with a new ileostomy three days post-op for IBD. The nurse notes that
the stoma is beefy red and has a scant amount of blood on it. What is the nurse's next action?
• A. Document these findings as normal.
,3
• B. Apply a barrier ointment to the stoma.
• C. Gently clean the stoma with an alcohol wipe.
• D. Scrub the stoma to remove the blood.
Rationale: A newly created stoma is expected to be red, moist, and may ooze a small amount of blood
due to its high vascularity. This is a normal finding and should be documented.
8. A 20-year-old patient is complaining of RLQ pain. When planning care for this patient, what would
be the priority nursing action?
• A. Administer an oral analgesic for the pain.
• B. Encourage the patient to ambulate.
• C. Monitor for signs of infection due to risk of rupture.
• D. Apply a heating pad to the abdomen to reduce discomfort.
Rationale: RLQ pain is a classic sign of appendicitis. The greatest risk is rupture, which can lead to
peritonitis, a life-threatening infection. The priority is to monitor the patient's vitals and pain level for
signs of worsening.
Hepatic & Biliary (9–60)
9. A nurse is caring for a client with cirrhosis who develops ascites. Which intervention should be
included in the plan of care?
A) High sodium diet
B) Daily weights and abdominal girth measurements
C) Restrict fluids to 500 mL/day
D) Encourage high-protein snacks
✅ B – Daily weights and abdominal girth are key to monitor fluid retention. Sodium restriction, not
high sodium, is indicated.
10. A client with hepatitis A asks how the virus is transmitted. The nurse should explain:
A) Blood and body fluids
B) Fecal-oral route
C) Respiratory droplets
D) Sexual contact
✅ B – Hepatitis A is transmitted via the fecal-oral route (contaminated food/water).
11. Which lab finding is most concerning in a client with cirrhosis and suspected hepatic
encephalopathy?
A) Ammonia 85 mcg/dL
B) Albumin 3.5 g/dL
, 4
C) Bilirubin 1.2 mg/dL
D) INR 1.1
✅ A – Elevated ammonia (> normal ~15-45) is associated with hepatic encephalopathy.
12. A client with esophageal varices has a new order for propranolol. The nurse knows this medication
is intended to:
A) Reduce portal pressure
B) Prevent bacterial peritonitis
C) Increase clotting factors
D) Decrease ascites
✅ A – Propranolol (beta-blocker) reduces portal hypertension and risk of variceal bleeding.
13. During an episode of active variceal bleeding, the priority intervention is:
A) Administer lactulose
B) Insert an NG tube for lavage
C) Prepare for endoscopic band ligation
D) Place client in Trendelenburg position
✅ C – Endoscopic band ligation is the definitive treatment for active variceal bleeding.
14. A client with pancreatitis has severe abdominal pain. Which position does the nurse encourage to
reduce pain?
A) Supine with legs flat
B) Lying on side with knees flexed (fetal position)
C) High-Fowler’s with legs dangling
D) Prone
✅ B – Fetal position reduces tension on the pancreas and may decrease pain.
15. The nurse expects which lab values in acute pancreatitis?
A) Elevated amylase and lipase
B) Elevated ALT and AST
C) Decreased WBC
D) Decreased blood glucose
✅ A – Amylase and lipase are elevated in acute pancreatitis.
16. A client after cholecystectomy reports severe RUQ pain and nausea. The nurse notes a
temperature of 101.5°F. The priority action is:
A) Administer prescribed antiemetic
B) Apply a warm compress to RUQ
C) Notify the provider immediately
D) Encourage deep breathing
✅ C – Fever and severe pain post-cholecystectomy could indicate a bile leak or peritonitis.
Exam 4 Final NSG 3800 Med Surg II Exam
Questions and Answers Practice Questions with
Solutions Newest | Already Graded A+
Practice Exam Questions (NCLEX-Style)
Test your knowledge with these questions. The correct answer is highlighted, followed by a detailed
rationale.
1. A nurse is visiting a client who has hypothyroidism and has been taking levothyroxine for 3 weeks.
It is a priority for the nurse to follow up if the client says what?
• A. "I still feel so tired all the time."
• B. "I haven't had a bowel movement in 2 days."
• C. "Sometimes my heart feels like it is racing and I get dizzy."
• D. "My skin is still dry and my hair is brittle."
Rationale: This statement indicates possible overmedication (hyperthyroidism symptoms), which can
lead to serious cardiac complications like tachycardia and arrhythmias. The priority is to prevent a
thyroid storm.
2. A nurse is caring for a patient diagnosed with adrenocortical deficiency (Addison's disease). The
nurse teaches the client about a new prescription for hydrocortisone. Which statement by the client
indicates an understanding of a key adverse effect?
• A. "I will need to avoid eating foods high in potassium."
• B. "I know this medication can make it harder for my body to fight off infections."
• C. "I should stop taking this medication if I start to feel better."
• D. "This medication will help me lose weight."
Rationale: Hydrocortisone is a corticosteroid, which causes immunosuppression, increasing the risk for
infection. Clients should be taught to report any signs of infection immediately.
3. A nurse is assessing a client who is 4 hours post-operative following a thyroidectomy. The client is
demonstrating spasms of the arm when a blood pressure cuff is inflated. The nurse should prepare to
immediately administer which of the following IV medications?
• A. Potassium Chloride
• B. Calcium Gluconate
,2
• C. Magnesium Sulfate
• D. Regular Insulin
Rationale: This positive Trousseau's sign indicates hypocalcemia due to accidental removal or damage of
the parathyroid glands during surgery. The priority treatment is IV calcium to prevent life-threatening
tetany and laryngeal spasms.
4. The nurse is admitting a client who is at risk for myxedema coma. Which of the following
interventions should the nurse include as a priority in the client's care plan?
• A. Initiate a fluid restriction to 1L per day.
• B. Avoid the use of hypnotic and sedative medications.
• C. Keep the client in a supine position.
• D. Administer oral thyroid replacement immediately.
Rationale: Clients with myxedema coma have a very low metabolic rate and are extremely sensitive to
central nervous system depressants. Sedatives can lead to respiratory depression and worsening coma.
5. A nurse is assessing a client who has hyperthyroidism and is at risk for developing a thyroid storm.
It is necessary for the nurse to notify the PCP if the client exhibits which of the following?
• A. A blood pressure of 110/70 mm Hg.
• B. A report of mild fatigue.
• C. Extreme tachycardia with a heart rate of 140 bpm.
• D. A low-grade fever of 99.5°F (37.5°C).
Rationale: Extreme tachycardia is a hallmark sign of thyroid storm, a life-threatening exacerbation of
hyperthyroidism. Other signs include high fever, delirium, and severe GI distress.
6. A patient came to the ED and was symptomatic for a small bowel obstruction. What should the
nurse do next?
• A. Administer a tap water enema.
• B. Prepare to insert an NG tube to decompress the bowel.
• C. Offer the patient small, frequent sips of water.
• D. Prepare the patient for an immediate colonoscopy.
Rationale: The priority for a bowel obstruction is to place the patient on NPO status and insert an NG
tube for gastric decompression to relieve pressure and prevent vomiting and aspiration.
7. A nurse is assessing a patient with a new ileostomy three days post-op for IBD. The nurse notes that
the stoma is beefy red and has a scant amount of blood on it. What is the nurse's next action?
• A. Document these findings as normal.
,3
• B. Apply a barrier ointment to the stoma.
• C. Gently clean the stoma with an alcohol wipe.
• D. Scrub the stoma to remove the blood.
Rationale: A newly created stoma is expected to be red, moist, and may ooze a small amount of blood
due to its high vascularity. This is a normal finding and should be documented.
8. A 20-year-old patient is complaining of RLQ pain. When planning care for this patient, what would
be the priority nursing action?
• A. Administer an oral analgesic for the pain.
• B. Encourage the patient to ambulate.
• C. Monitor for signs of infection due to risk of rupture.
• D. Apply a heating pad to the abdomen to reduce discomfort.
Rationale: RLQ pain is a classic sign of appendicitis. The greatest risk is rupture, which can lead to
peritonitis, a life-threatening infection. The priority is to monitor the patient's vitals and pain level for
signs of worsening.
Hepatic & Biliary (9–60)
9. A nurse is caring for a client with cirrhosis who develops ascites. Which intervention should be
included in the plan of care?
A) High sodium diet
B) Daily weights and abdominal girth measurements
C) Restrict fluids to 500 mL/day
D) Encourage high-protein snacks
✅ B – Daily weights and abdominal girth are key to monitor fluid retention. Sodium restriction, not
high sodium, is indicated.
10. A client with hepatitis A asks how the virus is transmitted. The nurse should explain:
A) Blood and body fluids
B) Fecal-oral route
C) Respiratory droplets
D) Sexual contact
✅ B – Hepatitis A is transmitted via the fecal-oral route (contaminated food/water).
11. Which lab finding is most concerning in a client with cirrhosis and suspected hepatic
encephalopathy?
A) Ammonia 85 mcg/dL
B) Albumin 3.5 g/dL
, 4
C) Bilirubin 1.2 mg/dL
D) INR 1.1
✅ A – Elevated ammonia (> normal ~15-45) is associated with hepatic encephalopathy.
12. A client with esophageal varices has a new order for propranolol. The nurse knows this medication
is intended to:
A) Reduce portal pressure
B) Prevent bacterial peritonitis
C) Increase clotting factors
D) Decrease ascites
✅ A – Propranolol (beta-blocker) reduces portal hypertension and risk of variceal bleeding.
13. During an episode of active variceal bleeding, the priority intervention is:
A) Administer lactulose
B) Insert an NG tube for lavage
C) Prepare for endoscopic band ligation
D) Place client in Trendelenburg position
✅ C – Endoscopic band ligation is the definitive treatment for active variceal bleeding.
14. A client with pancreatitis has severe abdominal pain. Which position does the nurse encourage to
reduce pain?
A) Supine with legs flat
B) Lying on side with knees flexed (fetal position)
C) High-Fowler’s with legs dangling
D) Prone
✅ B – Fetal position reduces tension on the pancreas and may decrease pain.
15. The nurse expects which lab values in acute pancreatitis?
A) Elevated amylase and lipase
B) Elevated ALT and AST
C) Decreased WBC
D) Decreased blood glucose
✅ A – Amylase and lipase are elevated in acute pancreatitis.
16. A client after cholecystectomy reports severe RUQ pain and nausea. The nurse notes a
temperature of 101.5°F. The priority action is:
A) Administer prescribed antiemetic
B) Apply a warm compress to RUQ
C) Notify the provider immediately
D) Encourage deep breathing
✅ C – Fever and severe pain post-cholecystectomy could indicate a bile leak or peritonitis.
