1
Understanding Medical Surgical Nursing – Davis Advantage
(7th Edition) by Williams and Hopper | Advanced/Hard
Difficulty | For Nursing Students & NCLEX-RN Preparation |
100% Pass Guaranteed | Graded A+
, 2
1. A 68-year-old male patient is admitted with a diagnosis of heart failure exacerbation. He
has a history of hypertension and chronic kidney disease stage 3. His current
medications include lisinopril, furosemide, and carvedilol. Which of the following
assessment findings is the most indicative of worsening renal function secondary to the
patient's current treatment regimen?
A. Serum creatinine increase from 1.2 mg/dL to 1.8 mg/dL
B. Serum potassium level of 5.1 mEq/L
C. Blood pressure of 142/88 mmHg
D. Urine output of 40 mL/hr
Correct Answer: A
☑ Explanation: An acute rise in serum creatinine (e.g., from 1.2 to 1.8 mg/dL)
indicates acute kidney injury (AKI), a critical adverse effect of ACE inhibitors (lisinopril)
and diuretics in the setting of heart failure, which can reduce renal perfusion. A
potassium of 5.1 (B) is mildly elevated but not as acutely indicative of worsening renal
function. A BP of 142/88 (C) is not ideal but is not the primary indicator of renal decline.
A urine output of 40 mL/hr (D) is within the normal range (>30 mL/hr).
, 3
2. A patient is admitted with hyponatremia (serum sodium 122 mEq/L) secondary to
SIADH. The provider orders 3% hypertonic saline to be infused at 25 mL/hr. The nurse
calculates the patient's fluid intake and output and notes a significant increase in urine
output. Which of the following is the most important nursing action based on this
change?
A. Increase the infusion rate of the 3% saline
B. Stop the infusion and notify the provider immediately
C. Continue the infusion as ordered and monitor the patient closely
D. Administer a dose of furosemide as a PRN order
Correct Answer: B
☑ Explanation: A sudden increase in urine output in a patient with SIADH
receiving hypertonic saline can cause a rapid rise in serum sodium, leading to osmotic
demyelination syndrome (central pontine myelinolysis). The infusion should be stopped
immediately, and the provider must be notified to reassess the patient's fluid and
electrolyte status. Increasing the rate (A) would be dangerous. Continuing the infusion
, 4
(C) could precipitate a rapid sodium correction. Administering furosemide (D) would
further worsen fluid loss and electrolyte imbalance.
3. A 52-year-old patient is post-operative day 1 following a right colectomy. The patient
has a nasogastric (NG) tube set to low intermittent suction. The nurse assesses the
patient and finds the abdomen to be distended and the patient reports nausea. The NG
tube is draining 150 mL of greenish fluid over the past 4 hours. Which of the following is
the nurse's priority action?
A. Irrigate the NG tube with 30 mL of normal saline
B. Reposition the patient to the left side
C. Check the placement of the NG tube by auscultating air insufflation
D. Assess the patency and function of the suction apparatus
Correct Answer: D
☑ Explanation: The patient's abdominal distention and nausea with an NG tube
in place indicate a potential malfunction of the suction apparatus, leading to inadequate
gastric decompression. The priority is to assess the patency and function of the suction
equipment. While irrigating (A) might be done, it is not the first action. Repositioning (B)
Understanding Medical Surgical Nursing – Davis Advantage
(7th Edition) by Williams and Hopper | Advanced/Hard
Difficulty | For Nursing Students & NCLEX-RN Preparation |
100% Pass Guaranteed | Graded A+
, 2
1. A 68-year-old male patient is admitted with a diagnosis of heart failure exacerbation. He
has a history of hypertension and chronic kidney disease stage 3. His current
medications include lisinopril, furosemide, and carvedilol. Which of the following
assessment findings is the most indicative of worsening renal function secondary to the
patient's current treatment regimen?
A. Serum creatinine increase from 1.2 mg/dL to 1.8 mg/dL
B. Serum potassium level of 5.1 mEq/L
C. Blood pressure of 142/88 mmHg
D. Urine output of 40 mL/hr
Correct Answer: A
☑ Explanation: An acute rise in serum creatinine (e.g., from 1.2 to 1.8 mg/dL)
indicates acute kidney injury (AKI), a critical adverse effect of ACE inhibitors (lisinopril)
and diuretics in the setting of heart failure, which can reduce renal perfusion. A
potassium of 5.1 (B) is mildly elevated but not as acutely indicative of worsening renal
function. A BP of 142/88 (C) is not ideal but is not the primary indicator of renal decline.
A urine output of 40 mL/hr (D) is within the normal range (>30 mL/hr).
, 3
2. A patient is admitted with hyponatremia (serum sodium 122 mEq/L) secondary to
SIADH. The provider orders 3% hypertonic saline to be infused at 25 mL/hr. The nurse
calculates the patient's fluid intake and output and notes a significant increase in urine
output. Which of the following is the most important nursing action based on this
change?
A. Increase the infusion rate of the 3% saline
B. Stop the infusion and notify the provider immediately
C. Continue the infusion as ordered and monitor the patient closely
D. Administer a dose of furosemide as a PRN order
Correct Answer: B
☑ Explanation: A sudden increase in urine output in a patient with SIADH
receiving hypertonic saline can cause a rapid rise in serum sodium, leading to osmotic
demyelination syndrome (central pontine myelinolysis). The infusion should be stopped
immediately, and the provider must be notified to reassess the patient's fluid and
electrolyte status. Increasing the rate (A) would be dangerous. Continuing the infusion
, 4
(C) could precipitate a rapid sodium correction. Administering furosemide (D) would
further worsen fluid loss and electrolyte imbalance.
3. A 52-year-old patient is post-operative day 1 following a right colectomy. The patient
has a nasogastric (NG) tube set to low intermittent suction. The nurse assesses the
patient and finds the abdomen to be distended and the patient reports nausea. The NG
tube is draining 150 mL of greenish fluid over the past 4 hours. Which of the following is
the nurse's priority action?
A. Irrigate the NG tube with 30 mL of normal saline
B. Reposition the patient to the left side
C. Check the placement of the NG tube by auscultating air insufflation
D. Assess the patency and function of the suction apparatus
Correct Answer: D
☑ Explanation: The patient's abdominal distention and nausea with an NG tube
in place indicate a potential malfunction of the suction apparatus, leading to inadequate
gastric decompression. The priority is to assess the patency and function of the suction
equipment. While irrigating (A) might be done, it is not the first action. Repositioning (B)
