CMSRN Medical-Surgical Nursing MCQ 3 — Questions and Answers
Question 1: A patient with liver cirrhosis develops confusion, asterixis, and elevated ammonia levels. Which dietary modification is most appropriate?
- Increase protein intake to promote healing
- Restrict protein to 0.5-1.0 g/kg/day (Correct answer)
- Provide a high-fat, low-carbohydrate diet
- Eliminate all dietary sodium
Correct answer: Restrict protein to 0.5-1.0 g/kg/day
Protein restriction reduces ammonia production from protein metabolism, helping to manage hepatic encephalopathy while maintaining adequate nutrition.
Question 2: A patient is 24 hours post-total knee replacement. Which finding indicates a potential deep vein thrombosis?
- Bilateral ankle edema
- Calf pain with dorsiflexion of the foot (Correct answer)
- Mild incisional pain rated 3/10
- Knee swelling at the surgical site
Correct answer: Calf pain with dorsiflexion of the foot
Calf pain with dorsiflexion (Homans' sign) may indicate DVT, though duplex ultrasound is required for definitive diagnosis.
Question 3: A patient with acute pancreatitis is prescribed nothing by mouth (NPO). After 48 hours the patient requests food. What is the nurse's best response?
- Provide clear liquids as tolerated
- Consult the dietitian before any food is given
- Explain that pancreatic rest is needed and foods stimulate enzyme secretion (Correct answer)
- Allow soft foods if bowel sounds are present
Correct answer: Explain that pancreatic rest is needed and foods stimulate enzyme secretion
Food stimulates pancreatic enzyme secretion, which worsens inflammation in acute pancreatitis; NPO status allows pancreatic rest and reduces enzyme-mediated autodigestion.
Question 4: Which parameter is the most accurate indicator of fluid resuscitation adequacy in a patient with burns covering 40% TBSA?
- Heart rate below 100 beats/min
- Urine output of 0.5-1 mL/kg/hr (Correct answer)
- Mean arterial pressure above 65 mmHg
- Central venous pressure of 8-12 mmHg
Correct answer: Urine output of 0.5-1 mL/kg/hr
Urine output of 0.5-1 mL/kg/hr is the gold-standard endpoint for Parkland formula fluid resuscitation in major burns, reflecting adequate renal perfusion.
Question 5: A patient taking warfarin has an INR of 5.8 and is not bleeding. Which action should the nurse anticipate?
- Administer IV vitamin K 10 mg
- Hold warfarin and monitor closely (Correct answer)
- Administer protamine sulfate
- Begin fresh frozen plasma transfusion
Correct answer: Hold warfarin and monitor closely
For supratherapeutic INR without active bleeding, the standard approach is to hold warfarin doses and monitor until INR returns to the therapeutic range.
Question 6: A patient with hypothyroidism is started on levothyroxine. Which symptom indicates the dose may be too high?
- Constipation
- Weight gain of 2 kg
- Palpitations and heat intolerance (Correct answer)
- Bradycardia
Correct answer: Palpitations and heat intolerance
Palpitations and heat intolerance are signs of hyperthyroidism, indicating over-replacement with levothyroxine.
Question 7: A patient with a small bowel obstruction has a nasogastric tube in place. Which finding indicates the tube is functioning properly?
- Patient reports relief of nausea
- Tube draining bile-colored fluid
- Absence of bowel sounds
- Abdominal girth decreasing (Correct answer)
Correct answer: Abdominal girth decreasing
Decreasing abdominal girth indicates the NG tube is effectively decompressing the bowel by removing accumulated gas and fluid proximal to the obstruction.
CMSRN Medical-Surgical Nursing MCQ 3
A patient with liver cirrhosis develops confusion, asterixis, and elevated ammonia levels.
Which dietary modification is most appropriate?