NUR 242 Medical-Surgical
Nursing Exam 3 Ultimate
Practice Package
, Question 1
A nurse is assessing a client admitted with acute pancreatitis. Which clinical
manifestation should the nurse prioritize as an indicator of hemorrhagic
pancreatitis?
A) Rigid, board-like abdomen with rebound tenderness
B) Bluish discoloration around the periumbilical area (Cullen's sign)
C) Severe, radiating left upper quadrant epigastric pain
D) Hyperactive bowel sounds in all four abdominal quadrants
VERIFIED ANSWER: B) Bluish discoloration around the periumbilical area
(Cullen's sign)
EXPLANATION: Cullen's sign (periumbilical ecchymosis) and Grey
Turner's sign (flank ecchymosis) indicate retroperitoneal hemorrhage
associated with severe necrotizing pancreatitis. While a rigid abdomen
indicates peritonitis and epigastric pain is expected, Cullen's sign is a direct
visual indicator of internal bleeding that requires immediate notification of
the provider to prevent hypovolemic shock. Hyperactive bowel sounds are
incorrect; paralytic ileus with hypoactive sounds is typical.
Question 2
, A client with a history of cirrhosis is admitted with a serum ammonia level of
112 mcg/dL and is exhibiting asterixis. Which medication instruction should the
nurse implement to evaluate the effectiveness of the prescribed therapy?
A) Monitor for an increase in daily urine output up to 3 liters.
B) Titrate the dose to achieve 2 to 3 soft, loose stools per day.
C) Hold the medication if the client develops a normal mental status.
D) Administer the drug with an antacid to decrease gastric irritation.
VERIFIED ANSWER: B) Titrate the dose to achieve 2 to 3 soft, loose stools
per day.
EXPLANATION: Lactulose is osmotic and works by trapping ammonia in the
gut (\(NH_{3}\) to \(NH_{4}^{+}\)) and expelling it via the stool. The
therapeutic goal of lactulose administration in hepatic encephalopathy is to
achieve 2 to 3 soft, formed or loose bowel movements daily. It does not target
urinary output, it must not be held when mental status normalizes (as that
shows maintenance efficacy), and it should not be mixed with antacids which
can alter gastrointestinal pH.
Question 3
The nurse is caring for a client who is 12 hours postoperative following a total
gastrectomy for gastric cancer. Which nursing intervention is a priority when
managing the client's nasogastric (NG) tube?
A) Irrigate the tube with 30 mL of sterile normal saline every 4 hours.
B) Securely anchor the tube and ensure it is not repositioned or irrigated.
, C) Advance the tube an additional 5 cm if drainage becomes thick.
D) Check tube placement by vigorously aspirating gastric contents.
VERIFIED ANSWER: B) Securely anchor the tube and ensure it is not
repositioned or irrigated.
EXPLANATION: Following a total gastrectomy or esophageal/gastric
surgery, the NG tube protects the surgical anastomosis line. It must never be
repositioned, advanced, irrigated, or manipulated without specific surgeon
orders, because doing so risks perforating or disrupting the suture line.
Aspiration or irrigation can create excessive pressure or tension on fresh
internal staples.
Question 4
A client diagnosed with severe ulcerative colitis is prescribed total parenteral
nutrition (TPN) via a central venous catheter. Which nursing action is essential
to prevent a metabolic complication of TPN?
A) Change the central venous catheter dressing every 24 hours.
B) Infuse the TPN solution at a rapid rate if the schedule falls behind.
C) Monitor blood glucose levels every 6 hours even if the client is not diabetic.
D) Keep the TPN solution hanging for up to 48 hours to minimize line breaks.
VERIFIED ANSWER: C) Monitor blood glucose levels every 6 hours even if
the client is not diabetic.
EXPLANATION: TPN contains high concentrations of dextrose (often 20%
to 50%). The pancreas may struggle to produce enough insulin initially to
handle this load, making hyperglycemia a major metabolic complication.
Nursing Exam 3 Ultimate
Practice Package
, Question 1
A nurse is assessing a client admitted with acute pancreatitis. Which clinical
manifestation should the nurse prioritize as an indicator of hemorrhagic
pancreatitis?
A) Rigid, board-like abdomen with rebound tenderness
B) Bluish discoloration around the periumbilical area (Cullen's sign)
C) Severe, radiating left upper quadrant epigastric pain
D) Hyperactive bowel sounds in all four abdominal quadrants
VERIFIED ANSWER: B) Bluish discoloration around the periumbilical area
(Cullen's sign)
EXPLANATION: Cullen's sign (periumbilical ecchymosis) and Grey
Turner's sign (flank ecchymosis) indicate retroperitoneal hemorrhage
associated with severe necrotizing pancreatitis. While a rigid abdomen
indicates peritonitis and epigastric pain is expected, Cullen's sign is a direct
visual indicator of internal bleeding that requires immediate notification of
the provider to prevent hypovolemic shock. Hyperactive bowel sounds are
incorrect; paralytic ileus with hypoactive sounds is typical.
Question 2
, A client with a history of cirrhosis is admitted with a serum ammonia level of
112 mcg/dL and is exhibiting asterixis. Which medication instruction should the
nurse implement to evaluate the effectiveness of the prescribed therapy?
A) Monitor for an increase in daily urine output up to 3 liters.
B) Titrate the dose to achieve 2 to 3 soft, loose stools per day.
C) Hold the medication if the client develops a normal mental status.
D) Administer the drug with an antacid to decrease gastric irritation.
VERIFIED ANSWER: B) Titrate the dose to achieve 2 to 3 soft, loose stools
per day.
EXPLANATION: Lactulose is osmotic and works by trapping ammonia in the
gut (\(NH_{3}\) to \(NH_{4}^{+}\)) and expelling it via the stool. The
therapeutic goal of lactulose administration in hepatic encephalopathy is to
achieve 2 to 3 soft, formed or loose bowel movements daily. It does not target
urinary output, it must not be held when mental status normalizes (as that
shows maintenance efficacy), and it should not be mixed with antacids which
can alter gastrointestinal pH.
Question 3
The nurse is caring for a client who is 12 hours postoperative following a total
gastrectomy for gastric cancer. Which nursing intervention is a priority when
managing the client's nasogastric (NG) tube?
A) Irrigate the tube with 30 mL of sterile normal saline every 4 hours.
B) Securely anchor the tube and ensure it is not repositioned or irrigated.
, C) Advance the tube an additional 5 cm if drainage becomes thick.
D) Check tube placement by vigorously aspirating gastric contents.
VERIFIED ANSWER: B) Securely anchor the tube and ensure it is not
repositioned or irrigated.
EXPLANATION: Following a total gastrectomy or esophageal/gastric
surgery, the NG tube protects the surgical anastomosis line. It must never be
repositioned, advanced, irrigated, or manipulated without specific surgeon
orders, because doing so risks perforating or disrupting the suture line.
Aspiration or irrigation can create excessive pressure or tension on fresh
internal staples.
Question 4
A client diagnosed with severe ulcerative colitis is prescribed total parenteral
nutrition (TPN) via a central venous catheter. Which nursing action is essential
to prevent a metabolic complication of TPN?
A) Change the central venous catheter dressing every 24 hours.
B) Infuse the TPN solution at a rapid rate if the schedule falls behind.
C) Monitor blood glucose levels every 6 hours even if the client is not diabetic.
D) Keep the TPN solution hanging for up to 48 hours to minimize line breaks.
VERIFIED ANSWER: C) Monitor blood glucose levels every 6 hours even if
the client is not diabetic.
EXPLANATION: TPN contains high concentrations of dextrose (often 20%
to 50%). The pancreas may struggle to produce enough insulin initially to
handle this load, making hyperglycemia a major metabolic complication.
