NU 192 Exam 3 V1 | NU 192 Medical-
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 3) | Galen
1. A nurse is providing discharge education for a client newly diagnosed with
Gastroesophageal Reflux Disease (GERD). Which of the following statements by the client
indicate a need for further teaching? Select all that apply.
A. I will sleep with the head of my bed elevated on blocks.
B. I should avoid drinking peppermint tea before bed.
C. I will eat a small snack right before I go to sleep to soak up acid.
D. I’ll try to eat three large meals a day instead of frequent small ones.
E. I should lose weight to help reduce the pressure on my stomach.
F. I will wait at least three hours after eating before I lie down.
Correct Answer: C, D
Explanation: GERD management focuses on reducing gastric distension and intra-
abdominal pressure. Eating right before sleep increases the risk of reflux during the night
due to the horizontal position and should be avoided. Large meals distend the stomach and
increase pressure on the lower esophageal sphincter, so small, frequent meals are the
preferred dietary pattern.
,2. A nurse is caring for a client in the oliguric phase of Acute Kidney Injury (AKI). Which of the
following clinical findings should the nurse expect?
A. Urine output of 600 mL/24 hours
B. Increased Serum Creatinine
C. Hypokalemia
D. Metabolic alkalosis
Correct Answer: B
Explanation: During the oliguric phase of AKI, urine output typically drops below 400 mL
per day. The kidneys are unable to excrete nitrogenous waste, leading to a rise in Serum
Creatinine and BUN levels. Electrolyte imbalances such as hyperkalemia and metabolic
acidosis are also characteristic findings in this stage.
3. The nurse is monitoring a client with cirrhosis who is receiving lactulose. Which of the
following indicates the medication is having the desired therapeutic effect?
A. The client has increased appetite.
B. The client’s bilirubin level has returned to normal.
C. The client has a reduction in abdominal girth.
D. The client’s serum ammonia level is decreasing.
Correct Answer: D
,Explanation: Lactulose is an osmotic laxative used to treat hepatic encephalopathy by
promoting the excretion of ammonia in the stool. A decrease in serum ammonia levels
indicates that the medication is effectively trapping and removing toxins. Improved mental
status and increased frequency of bowel movements are secondary indicators of success.
4. A nurse is assessing a client for suspected hyperthyroidism. Which clinical manifestations
should the nurse expect to observe? Select all that apply.
A. Heat intolerance
B. Bradycardia
C. Weight gain
D. Exophthalmos
E. Tachycardia
Correct Answer: A, D, E
Explanation: Hyperthyroidism results in a hypermetabolic state characterized by
increased heart rate and heat production. Exophthalmos, or bulging eyes, is a classic sign
specifically associated with Graves’ disease. Bradycardia and weight gain are more typically
associated with hypothyroidism rather than hyperthyroidism.
5. A client with Chronic Kidney Disease (CKD) is prescribed a low-potassium diet. Which food
choices by the client indicate a correct understanding of the diet? Select all that apply.
A. Apples
B. Bananas
, C. Green beans
D. Potatoes
E. Spinach
F. Cabbage
Correct Answer: A, C, F
Explanation: Apples, green beans, and cabbage are considered low-potassium food choices
suitable for a client with CKD. Bananas, potatoes, and spinach are very high in potassium
and must be restricted to prevent hyperkalemia. Consistent monitoring of electrolyte levels
is vital in managing advanced renal disease.
6. A nurse is assessing a client with acute cholecystitis. Which of the following findings is most
characteristic of this condition?
A. Pain in the left lower quadrant
B. Pain that radiates to the left shoulder
C. Murphy’s sign
D. Pain relieved by eating high-fat foods
Correct Answer: C
Explanation: Murphy’s sign is a classic assessment finding for cholecystitis where the
client experiences sharp pain and inspiratory arrest upon palpation of the right upper
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 3) | Galen
1. A nurse is providing discharge education for a client newly diagnosed with
Gastroesophageal Reflux Disease (GERD). Which of the following statements by the client
indicate a need for further teaching? Select all that apply.
A. I will sleep with the head of my bed elevated on blocks.
B. I should avoid drinking peppermint tea before bed.
C. I will eat a small snack right before I go to sleep to soak up acid.
D. I’ll try to eat three large meals a day instead of frequent small ones.
E. I should lose weight to help reduce the pressure on my stomach.
F. I will wait at least three hours after eating before I lie down.
Correct Answer: C, D
Explanation: GERD management focuses on reducing gastric distension and intra-
abdominal pressure. Eating right before sleep increases the risk of reflux during the night
due to the horizontal position and should be avoided. Large meals distend the stomach and
increase pressure on the lower esophageal sphincter, so small, frequent meals are the
preferred dietary pattern.
,2. A nurse is caring for a client in the oliguric phase of Acute Kidney Injury (AKI). Which of the
following clinical findings should the nurse expect?
A. Urine output of 600 mL/24 hours
B. Increased Serum Creatinine
C. Hypokalemia
D. Metabolic alkalosis
Correct Answer: B
Explanation: During the oliguric phase of AKI, urine output typically drops below 400 mL
per day. The kidneys are unable to excrete nitrogenous waste, leading to a rise in Serum
Creatinine and BUN levels. Electrolyte imbalances such as hyperkalemia and metabolic
acidosis are also characteristic findings in this stage.
3. The nurse is monitoring a client with cirrhosis who is receiving lactulose. Which of the
following indicates the medication is having the desired therapeutic effect?
A. The client has increased appetite.
B. The client’s bilirubin level has returned to normal.
C. The client has a reduction in abdominal girth.
D. The client’s serum ammonia level is decreasing.
Correct Answer: D
,Explanation: Lactulose is an osmotic laxative used to treat hepatic encephalopathy by
promoting the excretion of ammonia in the stool. A decrease in serum ammonia levels
indicates that the medication is effectively trapping and removing toxins. Improved mental
status and increased frequency of bowel movements are secondary indicators of success.
4. A nurse is assessing a client for suspected hyperthyroidism. Which clinical manifestations
should the nurse expect to observe? Select all that apply.
A. Heat intolerance
B. Bradycardia
C. Weight gain
D. Exophthalmos
E. Tachycardia
Correct Answer: A, D, E
Explanation: Hyperthyroidism results in a hypermetabolic state characterized by
increased heart rate and heat production. Exophthalmos, or bulging eyes, is a classic sign
specifically associated with Graves’ disease. Bradycardia and weight gain are more typically
associated with hypothyroidism rather than hyperthyroidism.
5. A client with Chronic Kidney Disease (CKD) is prescribed a low-potassium diet. Which food
choices by the client indicate a correct understanding of the diet? Select all that apply.
A. Apples
B. Bananas
, C. Green beans
D. Potatoes
E. Spinach
F. Cabbage
Correct Answer: A, C, F
Explanation: Apples, green beans, and cabbage are considered low-potassium food choices
suitable for a client with CKD. Bananas, potatoes, and spinach are very high in potassium
and must be restricted to prevent hyperkalemia. Consistent monitoring of electrolyte levels
is vital in managing advanced renal disease.
6. A nurse is assessing a client with acute cholecystitis. Which of the following findings is most
characteristic of this condition?
A. Pain in the left lower quadrant
B. Pain that radiates to the left shoulder
C. Murphy’s sign
D. Pain relieved by eating high-fat foods
Correct Answer: C
Explanation: Murphy’s sign is a classic assessment finding for cholecystitis where the
client experiences sharp pain and inspiratory arrest upon palpation of the right upper
