NSG 3800 Actual Adult Health II Med-Surg Exam 2026/2027 |
Complete Practice Questions & Answers | Galen College of
Nursing
UNIT 9 — ALTERATIONS IN METABOLISM
Questions 1–90
1. A patient with cirrhosis develops increasing abdominal distention and
peripheral edema. Which laboratory finding best explains the edema?
A. Increased serum sodium
B. Decreased serum albumin
C. Increased hemoglobin
D. Decreased serum bilirubin
Correct Answer: B. Decreased serum albumin
Rationale: The liver synthesizes albumin. Advanced liver dysfunction
can cause hypoalbuminemia, reducing plasma oncotic pressure and
promoting fluid movement into the interstitial and peritoneal spaces.
2. Which finding is most characteristic of hepatic encephalopathy?
A. Asterixis
B. Bradycardia
C. Hyperactive bowel sounds
D. Polyuria
Correct Answer: A. Asterixis
,Rationale: Asterixis, or “flapping tremor,” is a classic neurological
manifestation of hepatic encephalopathy. Accumulation of neurotoxins
such as ammonia contributes to altered mental status.
3. A patient with cirrhosis becomes confused and develops asterixis.
Which laboratory value should the nurse anticipate being elevated?
A. Serum ammonia
B. Serum calcium
C. Hemoglobin
D. Platelet count
Correct Answer: A. Serum ammonia
Rationale: Impaired hepatic detoxification allows ammonia and other
neurotoxins to accumulate, contributing to hepatic encephalopathy.
4. Which medication is commonly administered to reduce ammonia
absorption in a patient with hepatic encephalopathy?
A. Lactulose
B. Furosemide
C. Metformin
D. Levothyroxine
Correct Answer: A. Lactulose
Rationale: Lactulose promotes conversion of ammonia to ammonium in
the colon and increases stool elimination, reducing systemic ammonia
levels.
,5. Which stool pattern indicates that lactulose therapy for hepatic
encephalopathy is having its intended effect?
A. One hard stool weekly
B. Several soft stools daily
C. No bowel movements
D. Persistent constipation
Correct Answer: B. Several soft stools daily
Rationale: Lactulose is titrated to produce regular soft stools,
commonly around 2–3 per day, while avoiding severe diarrhea and
dehydration.
6. A patient with cirrhosis has prolonged PT/INR. What does this finding
primarily indicate?
A. Increased insulin production
B. Impaired hepatic synthesis of clotting factors
C. Excess erythropoietin production
D. Increased platelet production
Correct Answer: B. Impaired hepatic synthesis of clotting factors
Rationale: The liver produces many coagulation factors. Liver
dysfunction can therefore prolong PT/INR and increase bleeding risk.
7. Which assessment finding is commonly associated with chronic liver
disease?
, A. Jaundice
B. Severe bradycardia
C. Increased muscle mass
D. Clear sclera without discoloration
Correct Answer: A. Jaundice
Rationale: Jaundice results from accumulation of bilirubin and is
commonly associated with impaired hepatic processing or biliary
obstruction.
8. A patient with advanced cirrhosis has ascites. Which intervention is
appropriate?
A. Monitor abdominal girth
B. Encourage unrestricted sodium intake
C. Avoid daily weights
D. Encourage excessive fluid intake regardless of status
Correct Answer: A. Monitor abdominal girth
Rationale: Daily weight and abdominal-girth measurements help
evaluate fluid accumulation and response to treatment.
9. Which dietary modification is commonly prescribed for a patient with
significant ascites?
A. High-sodium diet
B. Sodium restriction
C. High-alcohol diet
D. Unrestricted processed foods
Complete Practice Questions & Answers | Galen College of
Nursing
UNIT 9 — ALTERATIONS IN METABOLISM
Questions 1–90
1. A patient with cirrhosis develops increasing abdominal distention and
peripheral edema. Which laboratory finding best explains the edema?
A. Increased serum sodium
B. Decreased serum albumin
C. Increased hemoglobin
D. Decreased serum bilirubin
Correct Answer: B. Decreased serum albumin
Rationale: The liver synthesizes albumin. Advanced liver dysfunction
can cause hypoalbuminemia, reducing plasma oncotic pressure and
promoting fluid movement into the interstitial and peritoneal spaces.
2. Which finding is most characteristic of hepatic encephalopathy?
A. Asterixis
B. Bradycardia
C. Hyperactive bowel sounds
D. Polyuria
Correct Answer: A. Asterixis
,Rationale: Asterixis, or “flapping tremor,” is a classic neurological
manifestation of hepatic encephalopathy. Accumulation of neurotoxins
such as ammonia contributes to altered mental status.
3. A patient with cirrhosis becomes confused and develops asterixis.
Which laboratory value should the nurse anticipate being elevated?
A. Serum ammonia
B. Serum calcium
C. Hemoglobin
D. Platelet count
Correct Answer: A. Serum ammonia
Rationale: Impaired hepatic detoxification allows ammonia and other
neurotoxins to accumulate, contributing to hepatic encephalopathy.
4. Which medication is commonly administered to reduce ammonia
absorption in a patient with hepatic encephalopathy?
A. Lactulose
B. Furosemide
C. Metformin
D. Levothyroxine
Correct Answer: A. Lactulose
Rationale: Lactulose promotes conversion of ammonia to ammonium in
the colon and increases stool elimination, reducing systemic ammonia
levels.
,5. Which stool pattern indicates that lactulose therapy for hepatic
encephalopathy is having its intended effect?
A. One hard stool weekly
B. Several soft stools daily
C. No bowel movements
D. Persistent constipation
Correct Answer: B. Several soft stools daily
Rationale: Lactulose is titrated to produce regular soft stools,
commonly around 2–3 per day, while avoiding severe diarrhea and
dehydration.
6. A patient with cirrhosis has prolonged PT/INR. What does this finding
primarily indicate?
A. Increased insulin production
B. Impaired hepatic synthesis of clotting factors
C. Excess erythropoietin production
D. Increased platelet production
Correct Answer: B. Impaired hepatic synthesis of clotting factors
Rationale: The liver produces many coagulation factors. Liver
dysfunction can therefore prolong PT/INR and increase bleeding risk.
7. Which assessment finding is commonly associated with chronic liver
disease?
, A. Jaundice
B. Severe bradycardia
C. Increased muscle mass
D. Clear sclera without discoloration
Correct Answer: A. Jaundice
Rationale: Jaundice results from accumulation of bilirubin and is
commonly associated with impaired hepatic processing or biliary
obstruction.
8. A patient with advanced cirrhosis has ascites. Which intervention is
appropriate?
A. Monitor abdominal girth
B. Encourage unrestricted sodium intake
C. Avoid daily weights
D. Encourage excessive fluid intake regardless of status
Correct Answer: A. Monitor abdominal girth
Rationale: Daily weight and abdominal-girth measurements help
evaluate fluid accumulation and response to treatment.
9. Which dietary modification is commonly prescribed for a patient with
significant ascites?
A. High-sodium diet
B. Sodium restriction
C. High-alcohol diet
D. Unrestricted processed foods
