NU 186 Exam 2 V2 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 2) | Galen
1. A nurse is caring for a client with a new diagnosis of Cirrhosis. Which of the following
clinical manifestations should the nurse expect to find? (Select All That Apply)
A. Asterixis
B. Ascites
C. Ecchymosis
D. Clay-colored stools
E. Spider angiomas
F. Generalized pruritus
Correct Answer: A, B, C, D, E, F
Explanation: Cirrhosis involves extensive scarring of the liver which leads to various
systemic manifestations. Asterixis, or ‘liver flap,’ is a classic sign of hepatic encephalopathy
due to elevated ammonia levels. Pruritus and clay-colored stools result from impaired bile
flow and bilirubin metabolism, while ecchymosis occurs due to decreased synthesis of
clotting factors. Ascites and spider angiomas are results of portal hypertension and
hormonal imbalances common in liver failure.
,2. A client is admitted with Diabetic Ketoacidosis (DKA). Which of the following laboratory
results is the nurse most likely to observe?
A. Serum Bicarbonate 12 mEq/L
B. Serum Potassium 3.1 mEq/L
C. Serum pH 7.45
D. Blood Glucose 150 mg/dL
Correct Answer: A
Explanation: In DKA, the breakdown of fats leads to the production of ketones, which are
acidic, resulting in metabolic acidosis. A serum bicarbonate level of 12 mEq/L reflects a
significant base deficit and is a diagnostic hallmark of this condition. While potassium
levels can fluctuate, they are typically elevated or normal initially due to the shift of ions
from the intracellular to extracellular space before treatment begins.
3. The nurse is providing education to a client prescribed Levothyroxine for hypothyroidism.
Which instruction is the most critical for the nurse to include?
A. Take the medication with a full glass of milk at bedtime
B. Double the dose if a day of medication is missed
C. Discontinue the medication once symptoms like fatigue improve
D. Take the medication on an empty stomach 30-60 minutes before breakfast
Correct Answer: D
,Explanation: Levothyroxine absorption is significantly altered by the presence of food,
minerals like calcium, and other medications. Therefore, it must be taken on an empty
stomach in the morning to ensure consistent therapeutic blood levels. Taking it with milk
or food would lead to subtherapeutic levels and a failure to manage the hypothyroid state
effectively.
4. A nurse is caring for a client with Addison’s Disease. Which of the following assessment
findings would indicate an Addisonian Crisis? (Select All That Apply)
A. Severe hypotension
B. Hyperglycemia
C. Tachycardia
D. Profound dehydration
E. Hypernatremia
Correct Answer: A, C, D
Explanation: Addisonian crisis is a life-threatening emergency caused by a severe
deficiency of cortisol and aldosterone. This leads to massive fluid loss, profound
dehydration, and vascular collapse (hypotension and tachycardia). Clients typically present
with hypoglycemia and hyponatremia, not hyperglycemia or hypernatremia, due to the lack
of glucocorticoids and mineralocorticoids.
, 5. A client with Hyperthyroidism is scheduled for a subtotal thyroidectomy. Which medication
should the nurse expect to administer preoperatively to decrease the vascularity of the
thyroid gland?
A. Propylthiouracil (PTU)
B. Methimazole
C. Levothyroxine
D. Lugol’s solution (Saturated Solution of Potassium Iodide)
Correct Answer: D
Explanation: Lugol’s solution is an iodine preparation used preoperatively to inhibit the
release of thyroid hormone and, most importantly, to reduce the vascularity of the gland.
By making the gland firmer and less vascular, the risk of hemorrhage during surgery is
significantly reduced. PTU and Methimazole are antithyroid drugs that block hormone
synthesis but do not have the same immediate effect on glandular vascularity.
6. A client is diagnosed with Cushing’s Syndrome. Which of the following physical
characteristics should the nurse expect to observe?
A. Weight loss and thin frame
B. Bronze pigmentation of the skin
C. Truncal obesity and moon face
D. Low blood pressure and bradycardia
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 2) | Galen
1. A nurse is caring for a client with a new diagnosis of Cirrhosis. Which of the following
clinical manifestations should the nurse expect to find? (Select All That Apply)
A. Asterixis
B. Ascites
C. Ecchymosis
D. Clay-colored stools
E. Spider angiomas
F. Generalized pruritus
Correct Answer: A, B, C, D, E, F
Explanation: Cirrhosis involves extensive scarring of the liver which leads to various
systemic manifestations. Asterixis, or ‘liver flap,’ is a classic sign of hepatic encephalopathy
due to elevated ammonia levels. Pruritus and clay-colored stools result from impaired bile
flow and bilirubin metabolism, while ecchymosis occurs due to decreased synthesis of
clotting factors. Ascites and spider angiomas are results of portal hypertension and
hormonal imbalances common in liver failure.
,2. A client is admitted with Diabetic Ketoacidosis (DKA). Which of the following laboratory
results is the nurse most likely to observe?
A. Serum Bicarbonate 12 mEq/L
B. Serum Potassium 3.1 mEq/L
C. Serum pH 7.45
D. Blood Glucose 150 mg/dL
Correct Answer: A
Explanation: In DKA, the breakdown of fats leads to the production of ketones, which are
acidic, resulting in metabolic acidosis. A serum bicarbonate level of 12 mEq/L reflects a
significant base deficit and is a diagnostic hallmark of this condition. While potassium
levels can fluctuate, they are typically elevated or normal initially due to the shift of ions
from the intracellular to extracellular space before treatment begins.
3. The nurse is providing education to a client prescribed Levothyroxine for hypothyroidism.
Which instruction is the most critical for the nurse to include?
A. Take the medication with a full glass of milk at bedtime
B. Double the dose if a day of medication is missed
C. Discontinue the medication once symptoms like fatigue improve
D. Take the medication on an empty stomach 30-60 minutes before breakfast
Correct Answer: D
,Explanation: Levothyroxine absorption is significantly altered by the presence of food,
minerals like calcium, and other medications. Therefore, it must be taken on an empty
stomach in the morning to ensure consistent therapeutic blood levels. Taking it with milk
or food would lead to subtherapeutic levels and a failure to manage the hypothyroid state
effectively.
4. A nurse is caring for a client with Addison’s Disease. Which of the following assessment
findings would indicate an Addisonian Crisis? (Select All That Apply)
A. Severe hypotension
B. Hyperglycemia
C. Tachycardia
D. Profound dehydration
E. Hypernatremia
Correct Answer: A, C, D
Explanation: Addisonian crisis is a life-threatening emergency caused by a severe
deficiency of cortisol and aldosterone. This leads to massive fluid loss, profound
dehydration, and vascular collapse (hypotension and tachycardia). Clients typically present
with hypoglycemia and hyponatremia, not hyperglycemia or hypernatremia, due to the lack
of glucocorticoids and mineralocorticoids.
, 5. A client with Hyperthyroidism is scheduled for a subtotal thyroidectomy. Which medication
should the nurse expect to administer preoperatively to decrease the vascularity of the
thyroid gland?
A. Propylthiouracil (PTU)
B. Methimazole
C. Levothyroxine
D. Lugol’s solution (Saturated Solution of Potassium Iodide)
Correct Answer: D
Explanation: Lugol’s solution is an iodine preparation used preoperatively to inhibit the
release of thyroid hormone and, most importantly, to reduce the vascularity of the gland.
By making the gland firmer and less vascular, the risk of hemorrhage during surgery is
significantly reduced. PTU and Methimazole are antithyroid drugs that block hormone
synthesis but do not have the same immediate effect on glandular vascularity.
6. A client is diagnosed with Cushing’s Syndrome. Which of the following physical
characteristics should the nurse expect to observe?
A. Weight loss and thin frame
B. Bronze pigmentation of the skin
C. Truncal obesity and moon face
D. Low blood pressure and bradycardia
