NUR242 Medical-Surgical Nursing Exam 4 Question
Bank (Latest 2026/2027 Edition) – Questions, Answers
& Detailed Rationales
Q1
A 58-year-old patient is admitted with acute pancreatitis and reports severe epigastric
pain radiating to the back. Which laboratory value is the most specific diagnostic
indicator for acute pancreatitis?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated serum alkaline phosphatase
D) Elevated serum bilirubin
Answer: B
Rationales:
● A: Serum amylase rises in pancreatitis but is less specific because it also
elevates in salivary gland disorders, intestinal obstruction, and mumps.
● B: Serum lipase is the most specific marker for acute pancreatitis because it is
produced solely by the pancreas and remains elevated longer than amylase.
● C: Alkaline phosphatase elevation indicates biliary obstruction or bone disease,
not pancreatic inflammation.
● D: Bilirubin elevation suggests cholestasis or hemolysis but is not specific for
pancreatitis diagnosis.
,Q2
A patient with chronic heart failure is prescribed spironolactone. The nurse should
monitor for which potential adverse effect?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Metabolic acidosis
Answer: A
Rationales:
● A: Spironolactone is a potassium-sparing aldosterone antagonist that blocks
sodium reabsorption and potassium excretion, causing potassium retention.
● B: Hypokalemia occurs with loop and thiazide diuretics, not potassium-sparing
agents like spironolactone.
● C: Spironolactone promotes natriuresis and may cause hyponatremia, not
hypernatremia.
● D: Spironolactone can cause metabolic acidosis in rare cases, but hyperkalemia
is the most clinically significant and common adverse effect requiring
monitoring.
Q3
A patient with type 2 diabetes presents with a blood glucose of 48 mg/dL, diaphoresis,
and confusion. After administering 15 grams of oral glucose, the nurse should reassess
the patient in how many minutes?
A) 5 minutes
B) 15 minutes
C) 30 minutes
D) 60 minutes
,Answer: B
Rationales:
● A: Five minutes is too brief for oral glucose absorption and reassessment.
● B: The American Diabetes Association recommends reassessing blood glucose
15 minutes after carbohydrate administration for hypoglycemia treatment.
● C: Thirty minutes delays intervention if the initial treatment was insufficient and
the patient remains hypoglycemic.
● D: Sixty minutes is an unsafe delay that could allow progression to severe
neuroglycopenia or seizures.
Q4
A patient post-thyroidectomy develops stridor and respiratory distress 6 hours after
surgery. Which complication should the nurse suspect first?
A) Thyroid storm
B) Recurrent laryngeal nerve injury
C) Hemorrhage with tracheal compression
D) Hypocalcemia with laryngospasm
Answer: C
Rationales:
● A: Thyroid storm presents with hyperthermia, tachycardia, and agitation hours to
days postoperatively, not acute airway obstruction with stridor.
● B: Recurrent laryngeal nerve injury causes hoarseness or voice changes but
typically does not produce acute stridor unless bilateral injury occurs.
● C: Postoperative hemorrhage into the neck compartment causes hematoma
formation that compresses the trachea, producing stridor and respiratory
distress requiring immediate intervention.
● D: Hypocalcemia causes laryngospasm and stridor but typically manifests 24–72
hours postoperatively, not within 6 hours.
, Q5
A patient with cirrhosis develops asterixis and confusion. Which nursing intervention is
the priority?
A) Restrict dietary protein intake
B) Administer lactulose as prescribed
C) Monitor for bleeding tendencies
D) Assess for signs of infection
Answer: B
Rationales:
● A: Protein restriction is no longer routinely recommended in hepatic
encephalopathy because it can worsen malnutrition and is not the immediate
priority.
● B: Lactulose acidifies the colonic lumen, traps ammonia as ammonium ions, and
promotes excretion, directly treating the hyperammonemia causing
encephalopathy.
● C: Bleeding monitoring is important in cirrhosis but does not address the acute
neuropsychiatric changes of encephalopathy.
● D: Infection can precipitate encephalopathy but treating the elevated ammonia is
the immediate priority for symptom resolution.
Q6
A patient with a newly placed permanent pacemaker reports hiccups that are persistent
and rhythmic. Which complication should the nurse suspect?
A) Lead dislodgement with diaphragmatic stimulation
B) Pacemaker syndrome
Bank (Latest 2026/2027 Edition) – Questions, Answers
& Detailed Rationales
Q1
A 58-year-old patient is admitted with acute pancreatitis and reports severe epigastric
pain radiating to the back. Which laboratory value is the most specific diagnostic
indicator for acute pancreatitis?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated serum alkaline phosphatase
D) Elevated serum bilirubin
Answer: B
Rationales:
● A: Serum amylase rises in pancreatitis but is less specific because it also
elevates in salivary gland disorders, intestinal obstruction, and mumps.
● B: Serum lipase is the most specific marker for acute pancreatitis because it is
produced solely by the pancreas and remains elevated longer than amylase.
● C: Alkaline phosphatase elevation indicates biliary obstruction or bone disease,
not pancreatic inflammation.
● D: Bilirubin elevation suggests cholestasis or hemolysis but is not specific for
pancreatitis diagnosis.
,Q2
A patient with chronic heart failure is prescribed spironolactone. The nurse should
monitor for which potential adverse effect?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Metabolic acidosis
Answer: A
Rationales:
● A: Spironolactone is a potassium-sparing aldosterone antagonist that blocks
sodium reabsorption and potassium excretion, causing potassium retention.
● B: Hypokalemia occurs with loop and thiazide diuretics, not potassium-sparing
agents like spironolactone.
● C: Spironolactone promotes natriuresis and may cause hyponatremia, not
hypernatremia.
● D: Spironolactone can cause metabolic acidosis in rare cases, but hyperkalemia
is the most clinically significant and common adverse effect requiring
monitoring.
Q3
A patient with type 2 diabetes presents with a blood glucose of 48 mg/dL, diaphoresis,
and confusion. After administering 15 grams of oral glucose, the nurse should reassess
the patient in how many minutes?
A) 5 minutes
B) 15 minutes
C) 30 minutes
D) 60 minutes
,Answer: B
Rationales:
● A: Five minutes is too brief for oral glucose absorption and reassessment.
● B: The American Diabetes Association recommends reassessing blood glucose
15 minutes after carbohydrate administration for hypoglycemia treatment.
● C: Thirty minutes delays intervention if the initial treatment was insufficient and
the patient remains hypoglycemic.
● D: Sixty minutes is an unsafe delay that could allow progression to severe
neuroglycopenia or seizures.
Q4
A patient post-thyroidectomy develops stridor and respiratory distress 6 hours after
surgery. Which complication should the nurse suspect first?
A) Thyroid storm
B) Recurrent laryngeal nerve injury
C) Hemorrhage with tracheal compression
D) Hypocalcemia with laryngospasm
Answer: C
Rationales:
● A: Thyroid storm presents with hyperthermia, tachycardia, and agitation hours to
days postoperatively, not acute airway obstruction with stridor.
● B: Recurrent laryngeal nerve injury causes hoarseness or voice changes but
typically does not produce acute stridor unless bilateral injury occurs.
● C: Postoperative hemorrhage into the neck compartment causes hematoma
formation that compresses the trachea, producing stridor and respiratory
distress requiring immediate intervention.
● D: Hypocalcemia causes laryngospasm and stridor but typically manifests 24–72
hours postoperatively, not within 6 hours.
, Q5
A patient with cirrhosis develops asterixis and confusion. Which nursing intervention is
the priority?
A) Restrict dietary protein intake
B) Administer lactulose as prescribed
C) Monitor for bleeding tendencies
D) Assess for signs of infection
Answer: B
Rationales:
● A: Protein restriction is no longer routinely recommended in hepatic
encephalopathy because it can worsen malnutrition and is not the immediate
priority.
● B: Lactulose acidifies the colonic lumen, traps ammonia as ammonium ions, and
promotes excretion, directly treating the hyperammonemia causing
encephalopathy.
● C: Bleeding monitoring is important in cirrhosis but does not address the acute
neuropsychiatric changes of encephalopathy.
● D: Infection can precipitate encephalopathy but treating the elevated ammonia is
the immediate priority for symptom resolution.
Q6
A patient with a newly placed permanent pacemaker reports hiccups that are persistent
and rhythmic. Which complication should the nurse suspect?
A) Lead dislodgement with diaphragmatic stimulation
B) Pacemaker syndrome
