NU 192 Exam 3 V2 | NU 192 Medical-
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 3) | Galen
1. A nurse is caring for a client with Chronic Kidney Disease (CKD). Which of the following
clinical manifestations should the nurse expect to find? (Select all that apply)
A. Hypertension
B. Edema
C. Hyperkalemia
D. Anemia
E. Hypotension
F. Metabolic Alkalosis
Correct Answer: A, B, C, D
Explanation: Chronic Kidney Disease leads to fluid retention and decreased sodium
excretion, which commonly causes hypertension and peripheral edema. The kidneys’
inability to excrete potassium results in hyperkalemia, a potentially life-threatening
electrolyte imbalance. Additionally, the decreased production of erythropoietin by the
failing kidneys leads to anemia.
,2. A client is scheduled for a paracentesis to treat symptomatic ascites. Which position should
the nurse assist the client into for this procedure?
A. Prone
B. Left lateral Sims
C. High-Fowler’s
D. Trendelenburg
Correct Answer: C
Explanation: The High-Fowler’s position allows the abdominal fluid to accumulate in the
lower part of the peritoneal cavity, making it easier to aspirate. It also facilitates
respiratory expansion by reducing the pressure of the fluid on the diaphragm. The nurse
should also ensure the client voids before the procedure to avoid bladder puncture.
3. A nurse is assessing a client with acute pancreatitis. Which finding is the highest priority to
report to the healthcare provider?
A. Epigastric pain radiating to the back
B. Serum amylase 3 times the normal limit
C. Muscle twitching and a positive Chvostek’s sign
D. Nausea and vomiting
Correct Answer: C
,Explanation: A positive Chvostek’s sign indicates hypocalcemia, which is a common and
serious complication of acute pancreatitis due to fat necrosis and calcium binding. Severe
hypocalcemia can lead to tetany, seizures, and laryngospasm, making it a higher priority
than expected pain or enzyme elevations. The nurse must monitor for cardiac arrhythmias
and provide calcium gluconate as ordered.
4. The nurse is providing discharge teaching to a client following a Transurethral Resection of
the Prostate (TURP). Which instruction should be included?
A. Increase intake of caffeinated beverages to stimulate urination.
B. Avoid heavy lifting for at least 3-6 weeks.
C. Expect bright red blood in the urine for the first two weeks.
D. Limit fluid intake to 1 liter per day to reduce bladder pressure.
Correct Answer: B
Explanation: The client should avoid heavy lifting and strenuous activity to prevent post-
operative bleeding from the prostatic bed. While pink-tinged urine is expected initially,
bright red bleeding with clots is a complication that must be reported. The client should
actually increase fluid intake to 2-3 liters per day to flush the bladder and prevent clot
formation.
5. A nurse is monitoring a client during the first hour of hemodialysis. The client complains of
a headache, nausea, and becomes increasingly restless. What is the nurse’s priority action?
A. Increase the blood flow rate of the dialysis machine.
, B. Notify the provider and prepare to slow the dialysis rate.
C. Administer an antiemetic as prescribed.
D. Bolus the client with 500 mL of Normal Saline.
Correct Answer: B
Explanation: These symptoms are indicative of Disequilibrium Syndrome, which occurs
when solutes are removed too rapidly from the blood during dialysis, leading to cerebral
edema. Slowing the dialysis rate or stopping the procedure is necessary to prevent further
neurological deterioration and seizures. The nurse must stay with the client and maintain a
safe environment while waiting for medical intervention.
6. A client with liver cirrhosis presents with elevated serum ammonia levels and hepatic
encephalopathy. Which medication should the nurse anticipate administering?
A. Lactulose
B. Spironolactone
C. Propranolol
D. Vitamin K
Correct Answer: A
Explanation: Lactulose is the primary treatment for hepatic encephalopathy as it
promotes the excretion of ammonia through the stool. It works by acidifying the colon,
which converts ammonia into ammonium, an ion that cannot be reabsorbed into the
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Exam 3) | Galen
1. A nurse is caring for a client with Chronic Kidney Disease (CKD). Which of the following
clinical manifestations should the nurse expect to find? (Select all that apply)
A. Hypertension
B. Edema
C. Hyperkalemia
D. Anemia
E. Hypotension
F. Metabolic Alkalosis
Correct Answer: A, B, C, D
Explanation: Chronic Kidney Disease leads to fluid retention and decreased sodium
excretion, which commonly causes hypertension and peripheral edema. The kidneys’
inability to excrete potassium results in hyperkalemia, a potentially life-threatening
electrolyte imbalance. Additionally, the decreased production of erythropoietin by the
failing kidneys leads to anemia.
,2. A client is scheduled for a paracentesis to treat symptomatic ascites. Which position should
the nurse assist the client into for this procedure?
A. Prone
B. Left lateral Sims
C. High-Fowler’s
D. Trendelenburg
Correct Answer: C
Explanation: The High-Fowler’s position allows the abdominal fluid to accumulate in the
lower part of the peritoneal cavity, making it easier to aspirate. It also facilitates
respiratory expansion by reducing the pressure of the fluid on the diaphragm. The nurse
should also ensure the client voids before the procedure to avoid bladder puncture.
3. A nurse is assessing a client with acute pancreatitis. Which finding is the highest priority to
report to the healthcare provider?
A. Epigastric pain radiating to the back
B. Serum amylase 3 times the normal limit
C. Muscle twitching and a positive Chvostek’s sign
D. Nausea and vomiting
Correct Answer: C
,Explanation: A positive Chvostek’s sign indicates hypocalcemia, which is a common and
serious complication of acute pancreatitis due to fat necrosis and calcium binding. Severe
hypocalcemia can lead to tetany, seizures, and laryngospasm, making it a higher priority
than expected pain or enzyme elevations. The nurse must monitor for cardiac arrhythmias
and provide calcium gluconate as ordered.
4. The nurse is providing discharge teaching to a client following a Transurethral Resection of
the Prostate (TURP). Which instruction should be included?
A. Increase intake of caffeinated beverages to stimulate urination.
B. Avoid heavy lifting for at least 3-6 weeks.
C. Expect bright red blood in the urine for the first two weeks.
D. Limit fluid intake to 1 liter per day to reduce bladder pressure.
Correct Answer: B
Explanation: The client should avoid heavy lifting and strenuous activity to prevent post-
operative bleeding from the prostatic bed. While pink-tinged urine is expected initially,
bright red bleeding with clots is a complication that must be reported. The client should
actually increase fluid intake to 2-3 liters per day to flush the bladder and prevent clot
formation.
5. A nurse is monitoring a client during the first hour of hemodialysis. The client complains of
a headache, nausea, and becomes increasingly restless. What is the nurse’s priority action?
A. Increase the blood flow rate of the dialysis machine.
, B. Notify the provider and prepare to slow the dialysis rate.
C. Administer an antiemetic as prescribed.
D. Bolus the client with 500 mL of Normal Saline.
Correct Answer: B
Explanation: These symptoms are indicative of Disequilibrium Syndrome, which occurs
when solutes are removed too rapidly from the blood during dialysis, leading to cerebral
edema. Slowing the dialysis rate or stopping the procedure is necessary to prevent further
neurological deterioration and seizures. The nurse must stay with the client and maintain a
safe environment while waiting for medical intervention.
6. A client with liver cirrhosis presents with elevated serum ammonia levels and hepatic
encephalopathy. Which medication should the nurse anticipate administering?
A. Lactulose
B. Spironolactone
C. Propranolol
D. Vitamin K
Correct Answer: A
Explanation: Lactulose is the primary treatment for hepatic encephalopathy as it
promotes the excretion of ammonia through the stool. It works by acidifying the colon,
which converts ammonia into ammonium, an ion that cannot be reabsorbed into the
