NRSG 201 Exam 4 V2 | NRSG 201 Med
Surg 1 | Actual Q&A with Rationale
(NRSG201 Exam 4) | Ivy Tech
1. A patient is admitted with suspected acute pancreatitis. Which laboratory result is most
specific in confirming this diagnosis?
A. Serum calcium of 8.2 mg/dL
B. Serum lipase level of 600 U/L
C. White blood cell count of 12,000/mm3
D. Serum amylase level of 150 U/L
Correct Answer: B
Serum lipase is more specific than amylase for diagnosing acute pancreatitis because it
stays elevated longer and is primarily produced by the pancreas. While amylase rises early,
it may return to normal within 24 to 72 hours even if inflammation persists. The elevated
lipase level combined with clinical symptoms like epigastric pain provides a definitive
diagnostic indicator for the clinician.
2. A nurse is providing discharge teaching for a patient with a new diagnosis of
Gastroesophageal Reflux Disease (GERD). Which instruction should the nurse include?
A. Lie flat for 30 minutes after each meal.
B. Drink a glass of milk before sleeping to coat the esophagus.
,C. Avoid eating within 3 hours of bedtime.
D. Increase intake of caffeinated beverages to stimulate digestion.
Correct Answer: C
Eating late at night increases gastric acid production and the risk of reflux while lying
down. Patients are advised to keep the head of the bed elevated and avoid recumbent
positions immediately after meals. Modifying lifestyle habits, such as avoiding triggers like
caffeine and alcohol, is essential for long-term management of GERD symptoms.
3. Which clinical manifestation would the nurse expect to find in a patient experiencing an
Addisonian crisis?
A. Hypertension and hypernatremia
B. Bradycardia and hypoglycemia
C. Hypotension and hyperkalemia
D. Hyperglycemia and peripheral edema
Correct Answer: C
Addisonian crisis is a life-threatening emergency caused by a severe deficiency of cortisol
and aldosterone. This leads to profound hypotension due to fluid loss and hyperkalemia
because the kidneys cannot excrete potassium effectively. Immediate intervention with
intravenous fluids and high-dose glucocorticoids is required to stabilize the patient’s
hemodynamic status.
,4. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse anticipate administering first?
A. Epoetin alfa
B. Sodium polystyrene sulfonate
C. Calcium carbonate
D. Furosemide
Correct Answer: B
Sodium polystyrene sulfonate (Kayexalate) works by exchanging sodium ions for
potassium ions in the intestine, effectively lowering the serum potassium level.
Hyperkalemia is a dangerous complication of CKD that can lead to fatal cardiac arrhythmias
if left untreated. The nurse must monitor the patient’s bowel function and cardiac rhythm
closely during this intervention.
5. What is the primary rationale for administering Lactulose to a patient with Cirrhosis and
hepatic encephalopathy?
A. To reduce portal vein pressure
B. To prevent gastrointestinal bleeding
C. To decrease serum bilirubin levels
D. To promote the excretion of ammonia through the stool
Correct Answer: D
, Lactulose acts as an osmotic laxative that traps ammonia in the colon and facilitates its
removal from the body via bowel movements. Hepatic encephalopathy is caused by the
accumulation of neurotoxins, primarily ammonia, which the damaged liver cannot detoxify.
The goal of therapy is to achieve two to three soft stools per day to ensure effective
reduction of neurotoxic levels.
6. A nurse is caring for a patient post-transurethral resection of the prostate (TURP). The
patient has a continuous bladder irrigation (CBI) running. What should the nurse do if the
urine output is bright red with numerous clots?
A. Decrease the rate of the irrigation fluid.
B. Document the finding as a normal postoperative occurrence.
C. Increase the rate of the irrigation fluid.
D. Clamp the urinary catheter immediately.
Correct Answer: C
Increasing the rate of the CBI helps flush the bladder more rapidly to prevent clot
formation and maintain catheter patency. Bright red drainage suggests active bleeding, and
the irrigation rate must be adjusted to keep the return flow pink or clear. If the catheter
becomes obstructed by clots, the nurse may need to manually irrigate the system using
sterile technique.
7. Which assessment finding is a hallmark sign of a perforated peptic ulcer?
A. Hyperactive bowel sounds in all quadrants
Surg 1 | Actual Q&A with Rationale
(NRSG201 Exam 4) | Ivy Tech
1. A patient is admitted with suspected acute pancreatitis. Which laboratory result is most
specific in confirming this diagnosis?
A. Serum calcium of 8.2 mg/dL
B. Serum lipase level of 600 U/L
C. White blood cell count of 12,000/mm3
D. Serum amylase level of 150 U/L
Correct Answer: B
Serum lipase is more specific than amylase for diagnosing acute pancreatitis because it
stays elevated longer and is primarily produced by the pancreas. While amylase rises early,
it may return to normal within 24 to 72 hours even if inflammation persists. The elevated
lipase level combined with clinical symptoms like epigastric pain provides a definitive
diagnostic indicator for the clinician.
2. A nurse is providing discharge teaching for a patient with a new diagnosis of
Gastroesophageal Reflux Disease (GERD). Which instruction should the nurse include?
A. Lie flat for 30 minutes after each meal.
B. Drink a glass of milk before sleeping to coat the esophagus.
,C. Avoid eating within 3 hours of bedtime.
D. Increase intake of caffeinated beverages to stimulate digestion.
Correct Answer: C
Eating late at night increases gastric acid production and the risk of reflux while lying
down. Patients are advised to keep the head of the bed elevated and avoid recumbent
positions immediately after meals. Modifying lifestyle habits, such as avoiding triggers like
caffeine and alcohol, is essential for long-term management of GERD symptoms.
3. Which clinical manifestation would the nurse expect to find in a patient experiencing an
Addisonian crisis?
A. Hypertension and hypernatremia
B. Bradycardia and hypoglycemia
C. Hypotension and hyperkalemia
D. Hyperglycemia and peripheral edema
Correct Answer: C
Addisonian crisis is a life-threatening emergency caused by a severe deficiency of cortisol
and aldosterone. This leads to profound hypotension due to fluid loss and hyperkalemia
because the kidneys cannot excrete potassium effectively. Immediate intervention with
intravenous fluids and high-dose glucocorticoids is required to stabilize the patient’s
hemodynamic status.
,4. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse anticipate administering first?
A. Epoetin alfa
B. Sodium polystyrene sulfonate
C. Calcium carbonate
D. Furosemide
Correct Answer: B
Sodium polystyrene sulfonate (Kayexalate) works by exchanging sodium ions for
potassium ions in the intestine, effectively lowering the serum potassium level.
Hyperkalemia is a dangerous complication of CKD that can lead to fatal cardiac arrhythmias
if left untreated. The nurse must monitor the patient’s bowel function and cardiac rhythm
closely during this intervention.
5. What is the primary rationale for administering Lactulose to a patient with Cirrhosis and
hepatic encephalopathy?
A. To reduce portal vein pressure
B. To prevent gastrointestinal bleeding
C. To decrease serum bilirubin levels
D. To promote the excretion of ammonia through the stool
Correct Answer: D
, Lactulose acts as an osmotic laxative that traps ammonia in the colon and facilitates its
removal from the body via bowel movements. Hepatic encephalopathy is caused by the
accumulation of neurotoxins, primarily ammonia, which the damaged liver cannot detoxify.
The goal of therapy is to achieve two to three soft stools per day to ensure effective
reduction of neurotoxic levels.
6. A nurse is caring for a patient post-transurethral resection of the prostate (TURP). The
patient has a continuous bladder irrigation (CBI) running. What should the nurse do if the
urine output is bright red with numerous clots?
A. Decrease the rate of the irrigation fluid.
B. Document the finding as a normal postoperative occurrence.
C. Increase the rate of the irrigation fluid.
D. Clamp the urinary catheter immediately.
Correct Answer: C
Increasing the rate of the CBI helps flush the bladder more rapidly to prevent clot
formation and maintain catheter patency. Bright red drainage suggests active bleeding, and
the irrigation rate must be adjusted to keep the return flow pink or clear. If the catheter
becomes obstructed by clots, the nurse may need to manually irrigate the system using
sterile technique.
7. Which assessment finding is a hallmark sign of a perforated peptic ulcer?
A. Hyperactive bowel sounds in all quadrants
