NUR 209 MED SURG II EXAM 2
NUR 209 Medical Surgical Nursing II Exam 2 Actual
Questions And Correct Verified Answers
NUR 209 Medical Surgical Nursing II Exam 2
A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with an exacerbation. The nurse notes that the patient's oxygen
saturation is 88% on room air, and the patient is using accessory muscles to
breathe. Which action should the nurse take first?A.Administer a high-flow
oxygen mask at 10 L/min. B. Place the patient in a high-Fowler's position. C.
Prepare for immediate intubation. D. Administer a sedative to reduce anxiety.
The priority intervention for a patient experiencing respiratory distress is to
optimize lung expansion and ease the work of breathing. Placing the patient in
a high-Fowler's position allows for maximum chest expansion and
diaphragmatic descent. High-flow oxygen can suppress the hypoxic drive in
COPD patients, potentially leading to CO2narcosis. Intubation is a last resort,
and sedatives can depress respiratory drive further.
1. The nurse is caring for a patient who underwent a thoracentesis one
hour ago. Which assessment finding requires immediate notification of
the healthcare provider? A. Mild discomfort at the insertion site. B.
Small amount of serosanguinous drainage on the dressing. C. Sudden
onset of shortness of breath and tachycardia.D.Blood pressure of
118/76 mmHg.Sudden shortness of breath and tachycadia after a
thoracentesis are classic signs ofa pneumothorax or hemothorax, which
are serious complications requiring immediate intervention.Mild
discomfort and small amounts of drainage are expected findings. Stable
blood pressure is a normal finding.
2. A patient with pneumonia has a nursing diagnosis of Ineffective
Airway Clearance related to thick secretions and fatigue.Which
intervention is most appropriate to include in the plan of care?
A.Restrict fluid intake to 1000 mnL/day.B. Encourage increased
,fluid intake up to 2-3 L/day if not contraindicated.C.
Teach the patient to suppress coughing to conserve energy. D.
Administer antitussive medications around the clock. Increasing fluid
intake helps liquefy secretions, making them easier to expectorate.
Restricting fluids would thicken secretions.Suppressing coughing
prevents the clearance ofsecretions,worsening the condition.
Antitussives are generally avoided unless the cough is non-productive
and interfering with rest,as
coughing is a protective mechanism.
3. The nurse is reviewing the arterial blood gas (ABG) results of a patient
with severe asthma: pH 7.30,PaCO2 55 mmHg, HCO3 24mEq/L,PaO2 70
mmHg.How should the nurse interpret these results? A. Metabolic Acidosis
B. Respiratory Acidosis C.Respiratory Alkalosis D. Metabolic Alkalosis The
pH is low (<7.35),indicating acidosis. The PaCO2 is
elevated(>4mmHg),indicating a respiratory cause. The HCO3 is within
normal limits,indicating no metabolic compensation has occurred yet. This
pattern represents uncompensated respiratory acidosis, common in acute
asthma exacerbations due to CO2 retention.
4. A patient is scheduled for a bronchoscopy.Which statement by the
patient indicates a need for further teaching? A. “ I will not eat or drink
anything for at least 6 hours before the procedure."B.“I understand that
my throat may be sore after the procedure." C.“I can drive myself home
after the procedure since it is just a scope. ” D. “ I need to remove my
dentures before the procedure. ” Bronchoscopy involves conscious
sedation and topical anesthesia.Patients cannot drive for 24 hours after
receiving sedation due to impaired judgment and reflexes.
Fasting,expecting a sore throat, and removing dentures are correct
understandings of the procedure.
5. The nurse is caring for a patient with a chest tube connected to a water-
seal drainage system. The nurse notices continuous bubbling in the water-
seal chamber. What is the nurse's best action? A.Document the finding as
normal.B. Clamp the chest tube immediately. C. Check the system for an
air leak.D.Increase the wall suction pressure. Continuous bubbling in the
water-seal chamber indicates an air leak in the system (either in the
tubing,connections, or from the patient's pleural space if there is a
persistent pneumothorax). Intermittent bubbling with coughing is
,normal. Clamping the tube is dangerous as it can lead to tension
pneumothorax. Increasing suction does not fix a leak.
6. A patient with tuberculosis (TB) is being discharged.Which instruction
is most critical for the nurse to emphasize regarding medication
adherence? A. “Take the medications only when you feel symptomatic.
” B. “ You must take all medications exactly as prescribed for the full
duration of therapy."C.“Stop taking the medications if your urine turns
orange." D.“You can skip doses if you experience nausea.” TB treatment
requires long-term multidrug therapy (usually 6-9 months) to prevent
relapse and the development of drug-resistant strains. Non-adherence is
the primary cause of treatment failure and resistance. Orange urine is a
normal side effect ofrifampin. Nausea should be reported,but doses
should not be skipped without consulting the provider.
7.The nurse is assessing a patient with suspected pulmonary embolism
(PE). Which clinical manifestation is most commonly associated with this
condition? A. Bradycardia and hypotension.B.Sudden onset of dyspnea
and pleuritic chest pain.C.Productive cough with green sputum. D.
Wheezing and prolonged expiration. Sudden dyspnea and pleuritic chest
pain (pain worsened by breathing) are hallmark signs ofPE.
Tachycardia,not bradycardia, is common. Green sputum suggests
infection like pneumonia. Wheezing is more characteristic of asthma or
COPD.
8. A patient with heart failure is prescribed furosemide (Lasix).Which
laboratory value should the nurse monitor most closely? A.Serum
Calcium B.Serum Potassium C.Serum Sodium D. Blood Urea Nitrogen
(BUN) Furosemnide is a loop diuretic that causes significant excretion of
potassium. Hypokalemia is a major risk and can lead to life-threatening
cardiac dysrhythmias.While BUN and sodium are monitored, potassium
is the priority safety concern.
9. The nurse is caring for a patient with acute respiratory distress
syndrome (ARDS). Which positioning strategy is recommended to
improve oxygenation? A. Supine position with head flat. B. Prone
positioning for 12-16 hours per day. C. Left lateral recumbent
position.D.Trendelenburg position. Prone positioning improves
ventilation-perfusion matching and recruits dorsal alveoli in
, patients with severe ARDS, significantly improving oxygenation.Supine
positioning can worsen V/Q mismatch. Trendelenburg increases
intracranial and intra-abdominal pressure, impairing diaphragmatic
movement.
10. A patient is diagnosed with community-acquired
pneumonia.Which vaccine should the nurse recommend to prevent
future occurrences, especially if the patient is over 65? A. Hepatitis B
vaccine B.Pneumococcal vaccine C. Human Papillomavirus (HPV)
vaccine D. Varicella vaccine The pneumococcal vaccine protects against
Streptococcus pneumoniae, the most common cause of bacterial
pneumonia. It is recommended for adults over 65 and those with chronic
conditions. The other vaccines do not prevent pneumonia.
11.The nurse is evaluating a patient's understanding of inhaler
use.Which step indicates correct technique for a metered-dose inhaler
(MDI) without a spacer? A. Inhale rapidly and deeply while pressing the
canister. B. Exhale fully, then press the canister while inhaling slowly
and deeply. C. Hold breath for 5seconds after inhalation. D. Rinse mouth
before using the inhaler.Correct MDI technique involves exhaling fully to
empty lungs,activating the inhaler at the start ofa slow, deepinhalation
to ensure medication reaches the lower airways, and holding breath for
10 seconds (not 5) to allow deposition. Rinsing is done after steroid
inhalers, not before.
12.A patient with a tracheostomy has dislodged their tube 2 days post-
insertion. What is the nurse's priority action? A.Call the respiratory
therapist. B. Insert a spare tracheostomy tube or perform bag-valve-
mask ventilation. C. Cover the stoma with a sterile dressing. D. Attempt
to reinsert the original tube immediately. In the early post-operative
period (first 7 days), the stomna tract is not established. If the tube
dislodges, the airway can close rapidly. The priority is to maintain the
airway, either by inserting a spare tube (iftrained and available) or using
bag-valve-mask ventilation over the stoma/mouth while calling for
help.Reinserting the original tube blindly can create a false passage.
13.Which finding in a patient with influenza requires immediate
isolation precautions? A. Fever of 101°F(38.3℃C).B.Positive
NUR 209 Medical Surgical Nursing II Exam 2 Actual
Questions And Correct Verified Answers
NUR 209 Medical Surgical Nursing II Exam 2
A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with an exacerbation. The nurse notes that the patient's oxygen
saturation is 88% on room air, and the patient is using accessory muscles to
breathe. Which action should the nurse take first?A.Administer a high-flow
oxygen mask at 10 L/min. B. Place the patient in a high-Fowler's position. C.
Prepare for immediate intubation. D. Administer a sedative to reduce anxiety.
The priority intervention for a patient experiencing respiratory distress is to
optimize lung expansion and ease the work of breathing. Placing the patient in
a high-Fowler's position allows for maximum chest expansion and
diaphragmatic descent. High-flow oxygen can suppress the hypoxic drive in
COPD patients, potentially leading to CO2narcosis. Intubation is a last resort,
and sedatives can depress respiratory drive further.
1. The nurse is caring for a patient who underwent a thoracentesis one
hour ago. Which assessment finding requires immediate notification of
the healthcare provider? A. Mild discomfort at the insertion site. B.
Small amount of serosanguinous drainage on the dressing. C. Sudden
onset of shortness of breath and tachycardia.D.Blood pressure of
118/76 mmHg.Sudden shortness of breath and tachycadia after a
thoracentesis are classic signs ofa pneumothorax or hemothorax, which
are serious complications requiring immediate intervention.Mild
discomfort and small amounts of drainage are expected findings. Stable
blood pressure is a normal finding.
2. A patient with pneumonia has a nursing diagnosis of Ineffective
Airway Clearance related to thick secretions and fatigue.Which
intervention is most appropriate to include in the plan of care?
A.Restrict fluid intake to 1000 mnL/day.B. Encourage increased
,fluid intake up to 2-3 L/day if not contraindicated.C.
Teach the patient to suppress coughing to conserve energy. D.
Administer antitussive medications around the clock. Increasing fluid
intake helps liquefy secretions, making them easier to expectorate.
Restricting fluids would thicken secretions.Suppressing coughing
prevents the clearance ofsecretions,worsening the condition.
Antitussives are generally avoided unless the cough is non-productive
and interfering with rest,as
coughing is a protective mechanism.
3. The nurse is reviewing the arterial blood gas (ABG) results of a patient
with severe asthma: pH 7.30,PaCO2 55 mmHg, HCO3 24mEq/L,PaO2 70
mmHg.How should the nurse interpret these results? A. Metabolic Acidosis
B. Respiratory Acidosis C.Respiratory Alkalosis D. Metabolic Alkalosis The
pH is low (<7.35),indicating acidosis. The PaCO2 is
elevated(>4mmHg),indicating a respiratory cause. The HCO3 is within
normal limits,indicating no metabolic compensation has occurred yet. This
pattern represents uncompensated respiratory acidosis, common in acute
asthma exacerbations due to CO2 retention.
4. A patient is scheduled for a bronchoscopy.Which statement by the
patient indicates a need for further teaching? A. “ I will not eat or drink
anything for at least 6 hours before the procedure."B.“I understand that
my throat may be sore after the procedure." C.“I can drive myself home
after the procedure since it is just a scope. ” D. “ I need to remove my
dentures before the procedure. ” Bronchoscopy involves conscious
sedation and topical anesthesia.Patients cannot drive for 24 hours after
receiving sedation due to impaired judgment and reflexes.
Fasting,expecting a sore throat, and removing dentures are correct
understandings of the procedure.
5. The nurse is caring for a patient with a chest tube connected to a water-
seal drainage system. The nurse notices continuous bubbling in the water-
seal chamber. What is the nurse's best action? A.Document the finding as
normal.B. Clamp the chest tube immediately. C. Check the system for an
air leak.D.Increase the wall suction pressure. Continuous bubbling in the
water-seal chamber indicates an air leak in the system (either in the
tubing,connections, or from the patient's pleural space if there is a
persistent pneumothorax). Intermittent bubbling with coughing is
,normal. Clamping the tube is dangerous as it can lead to tension
pneumothorax. Increasing suction does not fix a leak.
6. A patient with tuberculosis (TB) is being discharged.Which instruction
is most critical for the nurse to emphasize regarding medication
adherence? A. “Take the medications only when you feel symptomatic.
” B. “ You must take all medications exactly as prescribed for the full
duration of therapy."C.“Stop taking the medications if your urine turns
orange." D.“You can skip doses if you experience nausea.” TB treatment
requires long-term multidrug therapy (usually 6-9 months) to prevent
relapse and the development of drug-resistant strains. Non-adherence is
the primary cause of treatment failure and resistance. Orange urine is a
normal side effect ofrifampin. Nausea should be reported,but doses
should not be skipped without consulting the provider.
7.The nurse is assessing a patient with suspected pulmonary embolism
(PE). Which clinical manifestation is most commonly associated with this
condition? A. Bradycardia and hypotension.B.Sudden onset of dyspnea
and pleuritic chest pain.C.Productive cough with green sputum. D.
Wheezing and prolonged expiration. Sudden dyspnea and pleuritic chest
pain (pain worsened by breathing) are hallmark signs ofPE.
Tachycardia,not bradycardia, is common. Green sputum suggests
infection like pneumonia. Wheezing is more characteristic of asthma or
COPD.
8. A patient with heart failure is prescribed furosemide (Lasix).Which
laboratory value should the nurse monitor most closely? A.Serum
Calcium B.Serum Potassium C.Serum Sodium D. Blood Urea Nitrogen
(BUN) Furosemnide is a loop diuretic that causes significant excretion of
potassium. Hypokalemia is a major risk and can lead to life-threatening
cardiac dysrhythmias.While BUN and sodium are monitored, potassium
is the priority safety concern.
9. The nurse is caring for a patient with acute respiratory distress
syndrome (ARDS). Which positioning strategy is recommended to
improve oxygenation? A. Supine position with head flat. B. Prone
positioning for 12-16 hours per day. C. Left lateral recumbent
position.D.Trendelenburg position. Prone positioning improves
ventilation-perfusion matching and recruits dorsal alveoli in
, patients with severe ARDS, significantly improving oxygenation.Supine
positioning can worsen V/Q mismatch. Trendelenburg increases
intracranial and intra-abdominal pressure, impairing diaphragmatic
movement.
10. A patient is diagnosed with community-acquired
pneumonia.Which vaccine should the nurse recommend to prevent
future occurrences, especially if the patient is over 65? A. Hepatitis B
vaccine B.Pneumococcal vaccine C. Human Papillomavirus (HPV)
vaccine D. Varicella vaccine The pneumococcal vaccine protects against
Streptococcus pneumoniae, the most common cause of bacterial
pneumonia. It is recommended for adults over 65 and those with chronic
conditions. The other vaccines do not prevent pneumonia.
11.The nurse is evaluating a patient's understanding of inhaler
use.Which step indicates correct technique for a metered-dose inhaler
(MDI) without a spacer? A. Inhale rapidly and deeply while pressing the
canister. B. Exhale fully, then press the canister while inhaling slowly
and deeply. C. Hold breath for 5seconds after inhalation. D. Rinse mouth
before using the inhaler.Correct MDI technique involves exhaling fully to
empty lungs,activating the inhaler at the start ofa slow, deepinhalation
to ensure medication reaches the lower airways, and holding breath for
10 seconds (not 5) to allow deposition. Rinsing is done after steroid
inhalers, not before.
12.A patient with a tracheostomy has dislodged their tube 2 days post-
insertion. What is the nurse's priority action? A.Call the respiratory
therapist. B. Insert a spare tracheostomy tube or perform bag-valve-
mask ventilation. C. Cover the stoma with a sterile dressing. D. Attempt
to reinsert the original tube immediately. In the early post-operative
period (first 7 days), the stomna tract is not established. If the tube
dislodges, the airway can close rapidly. The priority is to maintain the
airway, either by inserting a spare tube (iftrained and available) or using
bag-valve-mask ventilation over the stoma/mouth while calling for
help.Reinserting the original tube blindly can create a false passage.
13.Which finding in a patient with influenza requires immediate
isolation precautions? A. Fever of 101°F(38.3℃C).B.Positive
