Exam 1 v2: NSG 4100/ NSG 4100 – Latest
2026/2027 Update – Advanced Medical-Surgical
Nursing Questions with Verified Answers and
Elaborated Solutions
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2026 / 2027 Academic Year
Q: A client who has been receiving radiation therapy for bladder cancer tells the nurse
that it feels as if she is voiding through the vagina. The nurse interprets that the client may
be experiencing which condition?
1.Rupture of the bladder
2.The development of a vesicovaginal fistula
3.Extreme stress caused by the diagnosis of cancer
4.Altered perineal sensation as a side effect of radiation therapy
2
Rationale: A vesicovaginal fistula is a genital fistula that occurs between the bladder and
vagina. The fistula is an abnormal opening between these two body parts and, if this occurs,
the client may experience drainage of urine through the vagina. The client's complaint is
not associated with options 1, 3, or 4.
Q: The nurse is teaching a client about the risk factors associated with colorectal cancer.
The nurse determines that further teaching is necessary related to colorectal cancer if the
client identifies which item as an associated risk factor?
1.Age younger than 50 years
2.History of colorectal polyps
3.Family history of colorectal cancer 4.Chronic inflammatory bowel disease
1
Rationale:Colorectal cancer risk factors include age older than 50 years, a family history of
the disease, colorectal polyps, and chronic inflammatory bowel disease.
Q: The nurse is assessing the perineal wound in a client who has returned from the
operating room following an abdominal perineal resection and notes serosanguineous
drainage from the wound. Which nursing intervention is most appropriate?
1.Clamp the surgical drain.
2.Change the dressing as prescribed.
3.Notify the health care provider (HCP). 4.Remove and replace the perineal packing.
2
Rationale:Immediately after surgery, profuse serosanguineous drainage from the perineal
wound is expected. Therefore, the nurse should change the dressing as prescribed. A
surgical drain should not be clamped because this action will cause the accumulation of
drainage within the tissue. The nurse does not need to notify the HCP at this time. Drains
and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse
should not remove the perineal packing.
Q: The nurse is reviewing the history of a client with bladder cancer. The nurse expects to
note documentation of which most common sign or symptom of this type of cancer?
1.Dysuria
2.Hematuria
3.Urgency on urination
4.Frequency of urination
2
Rationale:The most common sign in clients with cancer of the bladder is hematuria. The
client also may experience irritative voiding symptoms such as frequency, urgency, and
dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency,
and frequency of urination are also symptoms of a bladder infection.
Q: A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is
being assessed by the nurse. Which assessment findings would be consistent with acute
pancreatitis? Select all that apply.
1.Diarrhea
2.Black, tarry stools
3.Hyperactive bowel sounds
4.Gray-blue color at the flank
5.Abdominal guarding and tenderness 6.Left upper quadrant pain with radiation to the
back
4, 5, 6
Rationale:Grayish-blue discoloration at the flank is known as Grey-Turner's sign and occurs
as a result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity. The
client may demonstrate abdominal guarding and may complain of tenderness with
palpation. The pain associated with acute pancreatitis is often sudden in onset and is
located in the epigastric region or left upper quadrant with radiation to the back. The other
options are incorrect.
Q: The nurse is reviewing the prescription for a client admitted to the hospital with a
diagnosis of acute pancreatitis. Which interventions would the nurse expect to be
prescribed for the client? Select all that apply.
1.Maintain NPO (nothing by mouth) status.
2.Encourage coughing and deep breathing.
3.Give small, frequent high-calorie feedings.
4.Maintain the client in a supine and flat position.
5.Give hydromorphone intravenously as prescribed for pain.
6.Maintain intravenous fluids at 10 mL/hour to keep the vein open
1, 2, 5
Rationale:The client with acute pancreatitis normally is placed on NPO status to rest the
pancreas and suppress gastrointestinal secretions, so adequate intravenous hydration is
necessary. Because abdominal pain is a prominent symptom of pancreatitis, pain
medications such as morphine or hydromorphone are prescribed. Meperidine is avoided, as
it may cause seizures. Some clients experience lessened pain by assuming positions that flex
the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated
45 degrees decreases tension on the abdomen and may help to ease the pain. The client is
susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm,
which causes the client to take shallow, guarded abdominal breaths. Therefore, measures
such as turning, coughing, and deep breathing are instituted.
Q: The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that
there is documentation of the presence of asterixis. How should the nurse assess for its
presence?
1.Dorsiflex the client's foot.
2.Measure the abdominal girth.
3.Ask the client to extend the arms.
4.Instruct the client to lean forward.
3
Rationale:Asterixis is irregular flapping movements of the fingers and wrists when the
hands and arms are outstretched, with the palms down, wrists bent up, and fingers spread.
Asterixis is the most common and reliable sign that hepatic encephalopathy is developing.
Options 1, 2, and 4 are incorrect.
Q: The nurse is reviewing the laboratory results for a client with cirrhosis and notes that
the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse
suggest to the client?
1.Roast pork
2.Cheese omelet
3.Pasta with sauce
4.Tuna fish sandwich
3
Rationale:Cirrhosis is a chronic, progressive disease of the liver characterized by diffuse
degeneration and destruction of hepatocytes. The serum ammonia level assesses the ability
of the liver to deaminate protein byproducts. Normal reference interval is 10 to 80 mcg/dL
(6 to 47 mcmol/L). Most of the ammonia in the body is found in the gastrointestinal tract.
Protein provided by the diet is transported to the liver by the portal vein. The liver breaks
down protein, which results in the formation of ammonia. Foods high in protein should be
avoided since the client's ammonia level is elevated above the normal range; therefore,
pasta with sauce would be the best selection.
Q: The nurse is reviewing a client's record and notes that the health care provider has
documented that the client has chronic renal disease. On review of the laboratory results,
the nurse most likely would expect to note which finding?
1.Elevated creatinine level
2.Decreased hemoglobin level
3.Decreased red blood cell count
4.Increased number of white blood cells in the urine
1
Rationale:The creatinine level is the most specific laboratory test to determine renal
function. The creatinine level increases when at least 50% of renal function is lost. A
decreased hemoglobin level and red blood cell count are associated with anemia or blood
loss and not specifically with decreased renal function. Increased white blood cells in the
urine are noted with urinary tract infection.
Q: A week after kidney transplantation, a client develops a temperature of 101°F (38.3°C),
the blood pressure is elevated, and there is tenderness over the transplanted kidney. The
serum creatinine is rising and urine output is decreased. The x-ray indicates that the
transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates
which treatment?
1.Antibiotic therapy
2.Peritoneal dialysis
3.Removal of the transplanted kidney
4.Increased immunosuppression therapy
4
Rationale:Acute rejection most often occurs within 1 week after transplantation but can
occur any time posttransplantation. Clinical manifestations include fever, malaise, elevated
white blood cell count, acute hypertension, graft tenderness, and manifestations of
deteriorating renal function. Treatment consists of increasing immunosuppressive therapy.
Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly
transplanted kidney due to the recent surgery. Removal of the transplanted kidney is
indicated with hyperacute rejection, which occurs within 48 hours of the transplant
surgery.
Q: The client newly diagnosed with chronic kidney disease recently has begun
hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse
should assess the client during dialysis for which associated manifestations?
1.Hypertension, tachycardia, and fever
2.Hypotension, bradycardia, and hypothermia
3.Restlessness, irritability, and generalized weakness
4.Headache, deteriorating level of consciousness, and twitching
4
Rationale:Disequilibrium syndrome is characterized by headache, mental confusion,
decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity.
Disequilibrium syndrome is caused by rapid removal of solutes from the body during
hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal
of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic
gradient, causing increased intracranial pressure and onset of symptoms. The syndrome
most often occurs in clients who are new to dialysis and is prevented by dialyzing for
shorter times or at reduced blood flow rates. Tachycardia and fever are associated with
infection. Generalized weakness is associated with low blood pressure and anemia.
Restlessness and irritability are not associated with disequilibrium syndrome.
Q: A client presents to the emergency department with upper gastrointestinal bleeding
and is in moderate distress. In planning care, what is the priority nursing action for this
client?
1.Assessment of vital signs
2.Completion of abdominal examination
3.Insertion of the prescribed nasogastric tube
4.Thorough investigation of precipitating events
1
Rationale:The priority nursing action is to assess the vital signs. This would provide
information about the amount of blood loss that has occurred and provide a baseline by
which to monitor the progress of treatment. The client may be unable to provide subjective
data until the immediate physical needs are met. Although an abdominal examination and
an assessment of the precipitating events may be necessary, these actions are not the
priority. Insertion of a nasogastric tube is not the priority and will require a health care
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