NUR 115 MEDICAL-SURGICAL NURSING I MS 2026/27
EDITION Q&A COMPREHENSIVE EXAM GUIDE
[1] A nurse is caring for a postoperative patient who develops
sudden shortness of breath, tachypnea, and pleuritic chest pain.
The patient’s oxygen saturation drops to 88% on room air. Which
condition should the nurse suspect first?
A. Atelectasis
B. Pulmonary edema
C. Pulmonary embolism
D. Bronchospasm
Correct Answer: C
Explanation: Pulmonary embolism presents with sudden dyspnea,
tachypnea, pleuritic chest pain, and hypoxemia, especially in
postoperative patients due to venous stasis and hypercoagulability.
Atelectasis is more gradual, pulmonary edema typically includes
crackles and frothy sputum, and bronchospasm presents with
wheezing.
[2] A patient with heart failure is receiving furosemide 40 mg IV
twice daily. Which laboratory value requires immediate nursing
intervention?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 135 mEq/L
C. Serum creatinine 1.0 mg/dL
D. Blood urea nitrogen 18 mg/dL
,Correct Answer: A
*Explanation: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia (K+ <3.5 mEq/L) increases the risk of
cardiac dysrhythmias, especially in patients with heart failure who
may also be on digoxin. The other values are within normal
limits.*
[3] A nurse is teaching a patient with newly diagnosed
hypertension about lifestyle modifications. Which statement by
the patient indicates a need for further teaching?
A. “I will limit my sodium intake to less than 2,300 mg per day.”
B. “I should aim for at least 150 minutes of moderate exercise
weekly.”
C. “I can stop my medication once my blood pressure is normal.”
D. “I will reduce alcohol consumption to no more than one drink
daily for women.”
Correct Answer: C
Explanation: Hypertension is a chronic condition requiring lifelong
management. Stopping medication when BP normalizes can lead to
rebound hypertension and increased cardiovascular risk. The other
statements reflect accurate understanding of lifestyle modifications.
[4] A patient with chronic obstructive pulmonary disease (COPD)
has an arterial blood gas (ABG) showing: pH 7.32, PaCO2 68 mm
Hg, HCO3- 30 mEq/L. Which interpretation is correct?
A. Uncompensated respiratory acidosis
,B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Partially compensated metabolic acidosis
Correct Answer: B
*Explanation: The pH is low (acidosis), PaCO2 is elevated
(respiratory cause), and HCO3- is elevated (metabolic
compensation). Because the pH is still abnormal, compensation is
partial. In fully compensated, pH returns to normal range.*
[5] A nurse is caring for a patient receiving continuous enteral
nutrition via a nasogastric tube. Which intervention best reduces
the risk of aspiration pneumonia?
A. Flush the tube with 30 mL water every 4 hours
B. Elevate the head of the bed to 30–45 degrees
C. Change the feeding bag every 72 hours
D. Check gastric residual volume every 2 hours
Correct Answer: B
*Explanation: Elevating the head of the bed to 30–45 degrees uses
gravity to prevent regurgitation and aspiration. While checking
residual volumes and flushing are important, head-of-bed
elevation is the most effective aspiration prevention measure.*
[6] A patient with diabetes mellitus type 2 is admitted with
hyperglycemic hyperosmolar state (HHS). Which clinical finding is
most consistent with HHS rather than diabetic ketoacidosis (DKA)?
A. Serum glucose 850 mg/dL
, B. Serum ketones negative to small
C. Arterial pH 7.31
D. Anion gap 22 mEq/L
Correct Answer: B
Explanation: HHS is characterized by severe hyperglycemia,
profound dehydration, and minimal or no ketones due to sufficient
insulin to prevent lipolysis but not enough to prevent
hyperglycemia. DKA presents with moderate-to-large ketones and
metabolic acidosis.
[7] A postoperative patient reports incisional pain at 8 on a 0–10
scale. The nurse administers morphine 4 mg IV push. Thirty
minutes later, the patient’s respiratory rate is 8 breaths/minute
and oxygen saturation is 88%. Which medication should the nurse
prepare to administer?
A. Naloxone
B. Flumazenil
C. Epinephrine
D. Atropine
Correct Answer: A
Explanation: Naloxone is an opioid antagonist that reverses opioid-
induced respiratory depression. Flumazenil reverses
benzodiazepines, epinephrine treats anaphylaxis, and atropine
treats bradycardia. The presentation is classic for opioid overdose.
EDITION Q&A COMPREHENSIVE EXAM GUIDE
[1] A nurse is caring for a postoperative patient who develops
sudden shortness of breath, tachypnea, and pleuritic chest pain.
The patient’s oxygen saturation drops to 88% on room air. Which
condition should the nurse suspect first?
A. Atelectasis
B. Pulmonary edema
C. Pulmonary embolism
D. Bronchospasm
Correct Answer: C
Explanation: Pulmonary embolism presents with sudden dyspnea,
tachypnea, pleuritic chest pain, and hypoxemia, especially in
postoperative patients due to venous stasis and hypercoagulability.
Atelectasis is more gradual, pulmonary edema typically includes
crackles and frothy sputum, and bronchospasm presents with
wheezing.
[2] A patient with heart failure is receiving furosemide 40 mg IV
twice daily. Which laboratory value requires immediate nursing
intervention?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 135 mEq/L
C. Serum creatinine 1.0 mg/dL
D. Blood urea nitrogen 18 mg/dL
,Correct Answer: A
*Explanation: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia (K+ <3.5 mEq/L) increases the risk of
cardiac dysrhythmias, especially in patients with heart failure who
may also be on digoxin. The other values are within normal
limits.*
[3] A nurse is teaching a patient with newly diagnosed
hypertension about lifestyle modifications. Which statement by
the patient indicates a need for further teaching?
A. “I will limit my sodium intake to less than 2,300 mg per day.”
B. “I should aim for at least 150 minutes of moderate exercise
weekly.”
C. “I can stop my medication once my blood pressure is normal.”
D. “I will reduce alcohol consumption to no more than one drink
daily for women.”
Correct Answer: C
Explanation: Hypertension is a chronic condition requiring lifelong
management. Stopping medication when BP normalizes can lead to
rebound hypertension and increased cardiovascular risk. The other
statements reflect accurate understanding of lifestyle modifications.
[4] A patient with chronic obstructive pulmonary disease (COPD)
has an arterial blood gas (ABG) showing: pH 7.32, PaCO2 68 mm
Hg, HCO3- 30 mEq/L. Which interpretation is correct?
A. Uncompensated respiratory acidosis
,B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Partially compensated metabolic acidosis
Correct Answer: B
*Explanation: The pH is low (acidosis), PaCO2 is elevated
(respiratory cause), and HCO3- is elevated (metabolic
compensation). Because the pH is still abnormal, compensation is
partial. In fully compensated, pH returns to normal range.*
[5] A nurse is caring for a patient receiving continuous enteral
nutrition via a nasogastric tube. Which intervention best reduces
the risk of aspiration pneumonia?
A. Flush the tube with 30 mL water every 4 hours
B. Elevate the head of the bed to 30–45 degrees
C. Change the feeding bag every 72 hours
D. Check gastric residual volume every 2 hours
Correct Answer: B
*Explanation: Elevating the head of the bed to 30–45 degrees uses
gravity to prevent regurgitation and aspiration. While checking
residual volumes and flushing are important, head-of-bed
elevation is the most effective aspiration prevention measure.*
[6] A patient with diabetes mellitus type 2 is admitted with
hyperglycemic hyperosmolar state (HHS). Which clinical finding is
most consistent with HHS rather than diabetic ketoacidosis (DKA)?
A. Serum glucose 850 mg/dL
, B. Serum ketones negative to small
C. Arterial pH 7.31
D. Anion gap 22 mEq/L
Correct Answer: B
Explanation: HHS is characterized by severe hyperglycemia,
profound dehydration, and minimal or no ketones due to sufficient
insulin to prevent lipolysis but not enough to prevent
hyperglycemia. DKA presents with moderate-to-large ketones and
metabolic acidosis.
[7] A postoperative patient reports incisional pain at 8 on a 0–10
scale. The nurse administers morphine 4 mg IV push. Thirty
minutes later, the patient’s respiratory rate is 8 breaths/minute
and oxygen saturation is 88%. Which medication should the nurse
prepare to administer?
A. Naloxone
B. Flumazenil
C. Epinephrine
D. Atropine
Correct Answer: A
Explanation: Naloxone is an opioid antagonist that reverses opioid-
induced respiratory depression. Flumazenil reverses
benzodiazepines, epinephrine treats anaphylaxis, and atropine
treats bradycardia. The presentation is classic for opioid overdose.
