Exam 3: NUR 209 Medical-Surgical Nursing II
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Gastrointestinal, Hepatic Failure, Multi-Organ Dysfunction, & Acute Endocrine
Metabolic Crises
Q1: A 58-year-old male with cirrhosis presents with confusion, asterixis, and a musty sweet
breath odor. His ammonia level is elevated. The nurse is evaluating the effectiveness of lactulose
therapy. Which finding indicates the therapy is effective?
A. Patient has 4 watery stools per day
B. Serum ammonia level is unchanged
C. Patient reports increased abdominal distension
D. Improved mental status and decreased confusion
Correct Answer: D
Rationale: Correct because the primary therapeutic goal of lactulose in hepatic encephalopathy
is to reduce ammonia levels and improve neurologic function, not merely to produce bowel
movements. This patient's presentation is consistent with hepatic encephalopathy, and improved
mental status reflects reduced ammonia crossing the blood-brain barrier. The nurse must track
efficacy based on neurologic improvement rather than stool frequency alone.
,Q2: A 22-year-old female with Type 1 diabetes presents with blood glucose of 320 mg/dL, pH
7.28, HCO3 12 mEq/L, and positive serum ketones. Which finding distinguishes DKA from
HHS?
A. Presence of metabolic acidosis and ketones
B. Blood glucose greater than 600 mg/dL
C. Absence of Kussmaul respirations
D. Severe dehydration with altered mental status
Correct Answer: A
Rationale: Correct because DKA is characterized by metabolic acidosis (pH <7.3, HCO3 <15)
and positive ketones due to absolute insulin deficiency and lipolysis, whereas HHS presents with
pH >7.3 and absent ketones. This patient's glucose of 320 mg/dL and acidotic pH are classic for
DKA rather than HHS. The presence of Kussmaul respirations and ketones pathognomonically
differentiates DKA from the hyperosmolar state.
Q3: A 45-year-old female with hyperthyroidism develops fever of 104°F, heart rate of 158 bpm,
and severe agitation following an upper respiratory infection. Which medication should the nurse
prepare to administer FIRST?
A. Hydrocortisone 100 mg IV
B. Propranolol 1 mg IV
C. PTU (propylthiouracil) 600 mg loading dose
D. Potassium iodide (Lugol's solution)
Correct Answer: C
Rationale: Correct because PTU is the preferred antithyroid medication in thyroid storm as it
blocks both thyroid hormone synthesis and peripheral conversion of T4 to T3. This patient's
presentation of extreme hyperpyrexia, tachycardia, and agitation following infection is consistent
with thyroid storm triggered by infection. PTU must be administered before iodine solutions to
prevent iodine-induced hormone release.
, Q4: A 68-year-old male in septic shock develops worsening hypoxemia, oliguria, and elevated
liver enzymes 48 hours after admission. Which condition is this patient most likely developing?
A. Acute respiratory distress syndrome only
B. Multi-organ dysfunction syndrome (MODS)
C. Cardiogenic shock
D. Hepatic encephalopathy
Correct Answer: B
Rationale: Correct because MODS is defined as progressive failure of two or more distinct
organ systems, most commonly triggered by untreated septic shock. This patient demonstrates
pulmonary (hypoxemia), renal (oliguria), and hepatic (elevated enzymes) dysfunction, meeting
criteria for MODS. The sequential organ failure pattern beginning with respiratory compromise
is the classic presentation following septic shock progression.
Q5: A nurse is assessing a 62-year-old male with decompensated cirrhosis for signs of hepatic
encephalopathy. Select all that apply.
A. Pinpoint pupils
B. Asterixis (flapping tremor)
C. Fetor hepaticus (musty sweet breath)
D. Bradycardia
E. Altered mental status and confusion
Correct Answer: B, C, E
Rationale: Correct because asterixis is the hallmark clinical sign of hepatic encephalopathy,
resulting from toxic ammonia accumulation affecting neurologic function. Fetor hepaticus
represents the characteristic musty sweet breath odor caused by dimethyl sulfide accumulation in
liver failure. Altered mental status and confusion occur when ammonia crosses the blood-brain
barrier causing cerebral edema and neuronal dysfunction.
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Gastrointestinal, Hepatic Failure, Multi-Organ Dysfunction, & Acute Endocrine
Metabolic Crises
Q1: A 58-year-old male with cirrhosis presents with confusion, asterixis, and a musty sweet
breath odor. His ammonia level is elevated. The nurse is evaluating the effectiveness of lactulose
therapy. Which finding indicates the therapy is effective?
A. Patient has 4 watery stools per day
B. Serum ammonia level is unchanged
C. Patient reports increased abdominal distension
D. Improved mental status and decreased confusion
Correct Answer: D
Rationale: Correct because the primary therapeutic goal of lactulose in hepatic encephalopathy
is to reduce ammonia levels and improve neurologic function, not merely to produce bowel
movements. This patient's presentation is consistent with hepatic encephalopathy, and improved
mental status reflects reduced ammonia crossing the blood-brain barrier. The nurse must track
efficacy based on neurologic improvement rather than stool frequency alone.
,Q2: A 22-year-old female with Type 1 diabetes presents with blood glucose of 320 mg/dL, pH
7.28, HCO3 12 mEq/L, and positive serum ketones. Which finding distinguishes DKA from
HHS?
A. Presence of metabolic acidosis and ketones
B. Blood glucose greater than 600 mg/dL
C. Absence of Kussmaul respirations
D. Severe dehydration with altered mental status
Correct Answer: A
Rationale: Correct because DKA is characterized by metabolic acidosis (pH <7.3, HCO3 <15)
and positive ketones due to absolute insulin deficiency and lipolysis, whereas HHS presents with
pH >7.3 and absent ketones. This patient's glucose of 320 mg/dL and acidotic pH are classic for
DKA rather than HHS. The presence of Kussmaul respirations and ketones pathognomonically
differentiates DKA from the hyperosmolar state.
Q3: A 45-year-old female with hyperthyroidism develops fever of 104°F, heart rate of 158 bpm,
and severe agitation following an upper respiratory infection. Which medication should the nurse
prepare to administer FIRST?
A. Hydrocortisone 100 mg IV
B. Propranolol 1 mg IV
C. PTU (propylthiouracil) 600 mg loading dose
D. Potassium iodide (Lugol's solution)
Correct Answer: C
Rationale: Correct because PTU is the preferred antithyroid medication in thyroid storm as it
blocks both thyroid hormone synthesis and peripheral conversion of T4 to T3. This patient's
presentation of extreme hyperpyrexia, tachycardia, and agitation following infection is consistent
with thyroid storm triggered by infection. PTU must be administered before iodine solutions to
prevent iodine-induced hormone release.
, Q4: A 68-year-old male in septic shock develops worsening hypoxemia, oliguria, and elevated
liver enzymes 48 hours after admission. Which condition is this patient most likely developing?
A. Acute respiratory distress syndrome only
B. Multi-organ dysfunction syndrome (MODS)
C. Cardiogenic shock
D. Hepatic encephalopathy
Correct Answer: B
Rationale: Correct because MODS is defined as progressive failure of two or more distinct
organ systems, most commonly triggered by untreated septic shock. This patient demonstrates
pulmonary (hypoxemia), renal (oliguria), and hepatic (elevated enzymes) dysfunction, meeting
criteria for MODS. The sequential organ failure pattern beginning with respiratory compromise
is the classic presentation following septic shock progression.
Q5: A nurse is assessing a 62-year-old male with decompensated cirrhosis for signs of hepatic
encephalopathy. Select all that apply.
A. Pinpoint pupils
B. Asterixis (flapping tremor)
C. Fetor hepaticus (musty sweet breath)
D. Bradycardia
E. Altered mental status and confusion
Correct Answer: B, C, E
Rationale: Correct because asterixis is the hallmark clinical sign of hepatic encephalopathy,
resulting from toxic ammonia accumulation affecting neurologic function. Fetor hepaticus
represents the characteristic musty sweet breath odor caused by dimethyl sulfide accumulation in
liver failure. Altered mental status and confusion occur when ammonia crosses the blood-brain
barrier causing cerebral edema and neuronal dysfunction.
