NUR 265 / NUR265 EXAM 1 & 2 ADVANCED
CONCEPTS IN MEDICAL-SURGICAL NURSING
EXAM 1 & 2 | QUESTIONS AND ANSWERS
RATED A+ | 2026/2027
1. A patient with cirrhosis develops increasing abdominal girth and discomfort.
Which order is most likely?
A. Furosemide
B. Spironolactone
C. Beta-blockers
D. Albumin
Answer: B — Spironolactone
Rationale: Spironolactone, a potassium-sparing diuretic, is the preferred diuretic for
ascites in cirrhosis to minimize electrolyte imbalances and hypokalemia.
2. In cirrhosis with ascites, the nurse should monitor:
A. Serum magnesium
B. Daily weights
C. Sensation in extremities
D. Eye movements
Answer: B — Daily weights
Rationale: Daily weights help track fluid retention changes accurately in clients with
ascites.
3. Which vitamin absorption is impaired in cirrhosis and contributes to bleeding?
A. Vitamin A
B. Vitamin D
,C. Vitamin K
D. Vitamin E
Answer: C — Vitamin K
Rationale: Impaired bile production in cirrhosis reduces fat-soluble vitamin absorption,
especially Vitamin K, which is needed for clotting factor synthesis.
4. A patient with cirrhosis is confused and agitated. Which lab test helps identify
the cause?
A. AST/ALT
B. Ammonia
C. Bilirubin
D. Creatinine
Answer: B — Ammonia
Rationale: Elevated ammonia levels can indicate hepatic encephalopathy, which causes
confusion and agitation in liver disease.
5. Which assessment finding indicates worsening hepatic encephalopathy?
A. Fatigue
B. Asterixis and confusion
C. Jaundice
D. Ascites
Answer: B — Asterixis and confusion
Rationale: Neurologic changes, such as flapping tremor (asterixis) and confusion, are
hallmark signs of hepatic encephalopathy.
6. A patient with cirrhosis has jaundice. Which lab value would be elevated?
A. AST/ALT
B. Bilirubin
,C. Ammonia
D. Creatinine
Answer: B — Bilirubin
Rationale: Jaundice occurs due to bilirubin accumulation from impaired liver excretion.
7. A patient with cirrhosis develops increasing confusion and agitation. The nurse
notes asterixis. Which condition is most likely?
A. Hepatic encephalopathy
B. Cirrhotic cardiomyopathy
C. Spontaneous bacterial peritonitis
D. Hepatorenal syndrome
Answer: A — Hepatic encephalopathy
Rationale: Asterixis (flapping tremor) and confusion are classic signs of hepatic
encephalopathy due to elevated ammonia.
8. Which medication is used to treat hepatic encephalopathy?
A. Furosemide
B. Lactulose
C. Spironolactone
D. Octreotide
Answer: B — Lactulose
Rationale: Lactulose acidifies the colon, traps ammonia, and reduces serum ammonia
levels in hepatic encephalopathy.
9. A patient with cirrhosis and ascites is prescribed spironolactone. Which lab value
requires monitoring?
A. Serum sodium
B. Serum potassium
, C. Serum calcium
D. Serum magnesium
Answer: B — Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia is a risk,
especially in patients with renal impairment.
10. What is the primary nursing concern for a patient with ascites undergoing
paracentesis?
A. Infection prevention
B. Monitoring fluid and electrolyte shifts
C. Pain management
D. Nutritional support
Answer: B — Monitoring fluid and electrolyte shifts
Rationale: Paracentesis can remove large volumes of fluid rapidly, risking hypotension
and electrolyte imbalance.
11. A patient with cirrhosis and ascites has a paracentesis. Which lab finding
should be reported immediately?
A. Serum sodium 135 mEq/L
B. Serum albumin 3.0 g/dL
C. Serum potassium 5.8 mEq/L
D. Serum ammonia 70 mcg/dL
Answer: C — Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia (K >5.0 mEq/L) is life-threatening and can cause cardiac
arrhythmias. This is a critical lab value requiring immediate intervention.
12. A patient with cirrhosis and ascites is receiving diuretics. Which electrolyte
imbalance is a risk?
CONCEPTS IN MEDICAL-SURGICAL NURSING
EXAM 1 & 2 | QUESTIONS AND ANSWERS
RATED A+ | 2026/2027
1. A patient with cirrhosis develops increasing abdominal girth and discomfort.
Which order is most likely?
A. Furosemide
B. Spironolactone
C. Beta-blockers
D. Albumin
Answer: B — Spironolactone
Rationale: Spironolactone, a potassium-sparing diuretic, is the preferred diuretic for
ascites in cirrhosis to minimize electrolyte imbalances and hypokalemia.
2. In cirrhosis with ascites, the nurse should monitor:
A. Serum magnesium
B. Daily weights
C. Sensation in extremities
D. Eye movements
Answer: B — Daily weights
Rationale: Daily weights help track fluid retention changes accurately in clients with
ascites.
3. Which vitamin absorption is impaired in cirrhosis and contributes to bleeding?
A. Vitamin A
B. Vitamin D
,C. Vitamin K
D. Vitamin E
Answer: C — Vitamin K
Rationale: Impaired bile production in cirrhosis reduces fat-soluble vitamin absorption,
especially Vitamin K, which is needed for clotting factor synthesis.
4. A patient with cirrhosis is confused and agitated. Which lab test helps identify
the cause?
A. AST/ALT
B. Ammonia
C. Bilirubin
D. Creatinine
Answer: B — Ammonia
Rationale: Elevated ammonia levels can indicate hepatic encephalopathy, which causes
confusion and agitation in liver disease.
5. Which assessment finding indicates worsening hepatic encephalopathy?
A. Fatigue
B. Asterixis and confusion
C. Jaundice
D. Ascites
Answer: B — Asterixis and confusion
Rationale: Neurologic changes, such as flapping tremor (asterixis) and confusion, are
hallmark signs of hepatic encephalopathy.
6. A patient with cirrhosis has jaundice. Which lab value would be elevated?
A. AST/ALT
B. Bilirubin
,C. Ammonia
D. Creatinine
Answer: B — Bilirubin
Rationale: Jaundice occurs due to bilirubin accumulation from impaired liver excretion.
7. A patient with cirrhosis develops increasing confusion and agitation. The nurse
notes asterixis. Which condition is most likely?
A. Hepatic encephalopathy
B. Cirrhotic cardiomyopathy
C. Spontaneous bacterial peritonitis
D. Hepatorenal syndrome
Answer: A — Hepatic encephalopathy
Rationale: Asterixis (flapping tremor) and confusion are classic signs of hepatic
encephalopathy due to elevated ammonia.
8. Which medication is used to treat hepatic encephalopathy?
A. Furosemide
B. Lactulose
C. Spironolactone
D. Octreotide
Answer: B — Lactulose
Rationale: Lactulose acidifies the colon, traps ammonia, and reduces serum ammonia
levels in hepatic encephalopathy.
9. A patient with cirrhosis and ascites is prescribed spironolactone. Which lab value
requires monitoring?
A. Serum sodium
B. Serum potassium
, C. Serum calcium
D. Serum magnesium
Answer: B — Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia is a risk,
especially in patients with renal impairment.
10. What is the primary nursing concern for a patient with ascites undergoing
paracentesis?
A. Infection prevention
B. Monitoring fluid and electrolyte shifts
C. Pain management
D. Nutritional support
Answer: B — Monitoring fluid and electrolyte shifts
Rationale: Paracentesis can remove large volumes of fluid rapidly, risking hypotension
and electrolyte imbalance.
11. A patient with cirrhosis and ascites has a paracentesis. Which lab finding
should be reported immediately?
A. Serum sodium 135 mEq/L
B. Serum albumin 3.0 g/dL
C. Serum potassium 5.8 mEq/L
D. Serum ammonia 70 mcg/dL
Answer: C — Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia (K >5.0 mEq/L) is life-threatening and can cause cardiac
arrhythmias. This is a critical lab value requiring immediate intervention.
12. A patient with cirrhosis and ascites is receiving diuretics. Which electrolyte
imbalance is a risk?
