NUR 201 Adult Health I Advanced Prep:
Master Med-Surg Concepts Practice
Questions & Detailed Explanations
Subject: Medical-Surgical Nursing Concepts (NUR 201)
Question 1: A patient is admitted with a diagnosis of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). Upon assessment, the nurse notes a serum sodium level of 122 mEq/L and a
serum osmolality of 250 mOsm/kg. Which intervention is the most critical to prioritize in the
plan of care to prevent severe neurological sequelae?
A) Administer a 0.9% Normal Saline bolus at 200 mL/hr.
B) Implement strict fluid restriction as ordered.
C) Increase dietary sodium intake to 4 grams per day.
D) Administer IV Furosemide to increase urine output.
Correct Answer: B) Implement strict fluid restriction as ordered.
Explanation: In SIADH, the excessive release of ADH leads to water retention and dilutional
hyponatremia. The primary treatment to correct the serum osmolality and sodium level is fluid
restriction to prevent further hemodilution and potential cerebral edema. While hypertonic
saline (3% NaCl) might be used in severe symptomatic cases, 0.9% saline is often insufficient or
contraindicated in excess due to the risk of fluid volume overload. Furosemide is only indicated
if serum sodium is at least 125 mEq/L and the patient is not fluid-restricted, and dietary sodium
alone cannot counteract the massive water retention characteristic of this syndrome.
Question 2: A nurse is caring for a patient experiencing a vaso-occlusive crisis due to Sickle Cell
Anemia. Which of the following nursing actions best reflects an understanding of the
pathophysiology of this crisis?
A) Applying a cold compress to the affected joints to reduce inflammation.
B) Encouraging strict bed rest to decrease oxygen demand.
C) Initiating aggressive hydration with isotonic fluids.
D) Administering prophylactic broad-spectrum antibiotics.
Correct Answer: C) Initiating aggressive hydration with isotonic fluids.
,Explanation: Vaso-occlusive crises are triggered by the sickling of erythrocytes, which obstructs
blood flow and causes intense pain and ischemia. Aggressive hydration reduces blood viscosity
and promotes improved perfusion through the microvasculature. Cold compresses cause
vasoconstriction and should be avoided in favor of warmth. While rest is important, physical
therapy and gentle movement are often encouraged to prevent venous stasis. Antibiotics are only
used if an underlying infection is suspected as the precipitating cause, not as a blanket
prophylaxis for the crisis itself.
Question 3: A patient with chronic obstructive pulmonary disease (COPD) is being evaluated for
acute respiratory failure. The arterial blood gas (ABG) results are: pH 7.25, $PaCO_{2}$ 65
mmHg, $HCO_{3}^{-}$ 28 mEq/L, $PaO_{2}$ 58 mmHg. What is the nurse's priority
assessment?
A) Assess the patient's level of consciousness and airway patency.
B) Check the patient's potassium level for potential hyperkalemia.
C) Document the findings and prepare to initiate mechanical ventilation.
D) Increase the oxygen flow rate to 6 L/min to improve the $PaO_{2}$.
Correct Answer: A) Assess the patient's level of consciousness and airway patency.
Explanation: The ABG reveals uncompensated respiratory acidosis with severe hypoxemia. In
patients with chronic CO2 retention, the clinical status (specifically the neurological impact of
hypercapnia and hypoxemia) is more critical than the laboratory values alone. Mechanical
ventilation may eventually be required, but it is not the first step before clinical assessment.
Increasing oxygen to 6 L/min in a COPD patient with a hypoxic drive risks suppressing their
respiratory effort and worsening hypercapnia.
Question 4: A patient recovering from a thyroidectomy suddenly complains of perioral numbness
and tingling in the fingertips. Which assessment finding is most important to report to the
surgeon immediately?
A) A heart rate of 110 beats/min.
B) A positive Chvostek’s sign.
C) Drainage of 50 mL of serosanguinous fluid from the JP drain.
D) Mild hoarseness when speaking.
Correct Answer: B) A positive Chvostek’s sign.
Explanation: Perioral numbness and tingling are hallmark signs of hypocalcemia, a potential
complication of thyroidectomy due to accidental injury or removal of the parathyroid glands. A
,positive Chvostek’s sign (facial twitching in response to tapping the facial nerve) confirms
neuromuscular irritability associated with hypocalcemia, which can lead to tetany and airway
compromise. While tachycardia (A) should be noted, it is less specific to the life-threatening risk
of hypocalcemic tetany. Hoarseness (D) usually suggests laryngeal nerve irritation, and 50 mL
of drainage (C) is generally expected post-operatively.
Question 5: A patient with heart failure is prescribed spironolactone. The nurse recognizes that
this medication works by:
A) Inhibiting sodium reabsorption in the ascending loop of Henle.
B) Blocking the action of aldosterone in the distal tubule.
C) Preventing the conversion of Angiotensin I to Angiotensin II.
D) Increasing myocardial contractility via calcium sensitization.
Correct Answer: B) Blocking the action of aldosterone in the distal tubule.
Explanation: Spironolactone is an aldosterone antagonist (potassium-sparing diuretic). It blocks
the effect of aldosterone in the distal renal tubules, causing the excretion of sodium and water
while retaining potassium. Loop diuretics (like furosemide) work in the ascending loop of Henle
(A). ACE inhibitors prevent the conversion of Angiotensin I to II (C). Drugs like dobutamine
increase contractility (D), but are not mechanisms of spironolactone.
Question 6: Which laboratory finding would indicate the development of Disseminated
Intravascular Coagulation (DIC) in a patient with systemic sepsis?
A) Elevated fibrinogen levels.
B) Decreased Prothrombin Time (PT).
C) Elevated D-dimer levels.
D) Increased platelet count.
Correct Answer: C) Elevated D-dimer levels.
Explanation: DIC is characterized by the widespread activation of the clotting cascade, which
paradoxically leads to both massive clotting and hemorrhage due to the consumption of clotting
factors. D-dimer is a degradation product of fibrin; its elevation indicates active, widespread
fibrinolysis occurring after massive clot formation. Fibrinogen and platelets (A & D) are
consumed and thus typically decrease in DIC, and PT (B) typically prolongs, not shortens.
Question 7: A patient is scheduled for an esophagogastroduodenoscopy (EGD). Which nursing
action is essential during the post-procedural recovery period?
, A) Encourage the patient to drink clear liquids immediately upon return.
B) Assess for a return of the gag reflex before allowing oral intake.
C) Position the patient in a prone position to prevent aspiration.
D) Check the patient for signs of post-procedure diarrhea.
Correct Answer: B) Assess for a return of the gag reflex before allowing oral intake.
Explanation: During an EGD, the patient's throat is anesthetized with a local spray, which
suppresses the gag reflex. Allowing oral intake before this reflex returns poses a significant risk
of aspiration. The patient should be kept NPO until the gag reflex is fully restored. Prone
positioning is not standard, and diarrhea is not a primary concern post-EGD.
Question 8: A client with chronic kidney disease (CKD) is prescribed epoetin alfa. The nurse
determines the medication is effective by observing:
A) A decrease in blood pressure.
B) An increase in serum creatinine.
C) An increase in hemoglobin and hematocrit levels.
D) A decrease in serum phosphate levels.
Correct Answer: C) An increase in hemoglobin and hematocrit levels.
Explanation: Epoetin alfa is a synthetic erythropoietin used to treat anemia associated with
chronic kidney disease by stimulating the bone marrow to produce red blood cells. Its
therapeutic effect is measured by improved RBC indices (hemoglobin/hematocrit). It does not
lower blood pressure (it can actually increase it), and it has no direct effect on creatinine or
phosphate levels.
Question 9: A patient is admitted with a suspected pulmonary embolism (PE). What is the
priority nursing intervention while waiting for diagnostic confirmation?
A) Administering a bolus of intravenous heparin.
B) Elevating the head of the bed and initiating supplemental oxygen.
C) Encouraging early ambulation to prevent further clot formation.
D) Performing a focused neurological assessment.
Correct Answer: B) Elevating the head of the bed and initiating supplemental oxygen.
Master Med-Surg Concepts Practice
Questions & Detailed Explanations
Subject: Medical-Surgical Nursing Concepts (NUR 201)
Question 1: A patient is admitted with a diagnosis of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). Upon assessment, the nurse notes a serum sodium level of 122 mEq/L and a
serum osmolality of 250 mOsm/kg. Which intervention is the most critical to prioritize in the
plan of care to prevent severe neurological sequelae?
A) Administer a 0.9% Normal Saline bolus at 200 mL/hr.
B) Implement strict fluid restriction as ordered.
C) Increase dietary sodium intake to 4 grams per day.
D) Administer IV Furosemide to increase urine output.
Correct Answer: B) Implement strict fluid restriction as ordered.
Explanation: In SIADH, the excessive release of ADH leads to water retention and dilutional
hyponatremia. The primary treatment to correct the serum osmolality and sodium level is fluid
restriction to prevent further hemodilution and potential cerebral edema. While hypertonic
saline (3% NaCl) might be used in severe symptomatic cases, 0.9% saline is often insufficient or
contraindicated in excess due to the risk of fluid volume overload. Furosemide is only indicated
if serum sodium is at least 125 mEq/L and the patient is not fluid-restricted, and dietary sodium
alone cannot counteract the massive water retention characteristic of this syndrome.
Question 2: A nurse is caring for a patient experiencing a vaso-occlusive crisis due to Sickle Cell
Anemia. Which of the following nursing actions best reflects an understanding of the
pathophysiology of this crisis?
A) Applying a cold compress to the affected joints to reduce inflammation.
B) Encouraging strict bed rest to decrease oxygen demand.
C) Initiating aggressive hydration with isotonic fluids.
D) Administering prophylactic broad-spectrum antibiotics.
Correct Answer: C) Initiating aggressive hydration with isotonic fluids.
,Explanation: Vaso-occlusive crises are triggered by the sickling of erythrocytes, which obstructs
blood flow and causes intense pain and ischemia. Aggressive hydration reduces blood viscosity
and promotes improved perfusion through the microvasculature. Cold compresses cause
vasoconstriction and should be avoided in favor of warmth. While rest is important, physical
therapy and gentle movement are often encouraged to prevent venous stasis. Antibiotics are only
used if an underlying infection is suspected as the precipitating cause, not as a blanket
prophylaxis for the crisis itself.
Question 3: A patient with chronic obstructive pulmonary disease (COPD) is being evaluated for
acute respiratory failure. The arterial blood gas (ABG) results are: pH 7.25, $PaCO_{2}$ 65
mmHg, $HCO_{3}^{-}$ 28 mEq/L, $PaO_{2}$ 58 mmHg. What is the nurse's priority
assessment?
A) Assess the patient's level of consciousness and airway patency.
B) Check the patient's potassium level for potential hyperkalemia.
C) Document the findings and prepare to initiate mechanical ventilation.
D) Increase the oxygen flow rate to 6 L/min to improve the $PaO_{2}$.
Correct Answer: A) Assess the patient's level of consciousness and airway patency.
Explanation: The ABG reveals uncompensated respiratory acidosis with severe hypoxemia. In
patients with chronic CO2 retention, the clinical status (specifically the neurological impact of
hypercapnia and hypoxemia) is more critical than the laboratory values alone. Mechanical
ventilation may eventually be required, but it is not the first step before clinical assessment.
Increasing oxygen to 6 L/min in a COPD patient with a hypoxic drive risks suppressing their
respiratory effort and worsening hypercapnia.
Question 4: A patient recovering from a thyroidectomy suddenly complains of perioral numbness
and tingling in the fingertips. Which assessment finding is most important to report to the
surgeon immediately?
A) A heart rate of 110 beats/min.
B) A positive Chvostek’s sign.
C) Drainage of 50 mL of serosanguinous fluid from the JP drain.
D) Mild hoarseness when speaking.
Correct Answer: B) A positive Chvostek’s sign.
Explanation: Perioral numbness and tingling are hallmark signs of hypocalcemia, a potential
complication of thyroidectomy due to accidental injury or removal of the parathyroid glands. A
,positive Chvostek’s sign (facial twitching in response to tapping the facial nerve) confirms
neuromuscular irritability associated with hypocalcemia, which can lead to tetany and airway
compromise. While tachycardia (A) should be noted, it is less specific to the life-threatening risk
of hypocalcemic tetany. Hoarseness (D) usually suggests laryngeal nerve irritation, and 50 mL
of drainage (C) is generally expected post-operatively.
Question 5: A patient with heart failure is prescribed spironolactone. The nurse recognizes that
this medication works by:
A) Inhibiting sodium reabsorption in the ascending loop of Henle.
B) Blocking the action of aldosterone in the distal tubule.
C) Preventing the conversion of Angiotensin I to Angiotensin II.
D) Increasing myocardial contractility via calcium sensitization.
Correct Answer: B) Blocking the action of aldosterone in the distal tubule.
Explanation: Spironolactone is an aldosterone antagonist (potassium-sparing diuretic). It blocks
the effect of aldosterone in the distal renal tubules, causing the excretion of sodium and water
while retaining potassium. Loop diuretics (like furosemide) work in the ascending loop of Henle
(A). ACE inhibitors prevent the conversion of Angiotensin I to II (C). Drugs like dobutamine
increase contractility (D), but are not mechanisms of spironolactone.
Question 6: Which laboratory finding would indicate the development of Disseminated
Intravascular Coagulation (DIC) in a patient with systemic sepsis?
A) Elevated fibrinogen levels.
B) Decreased Prothrombin Time (PT).
C) Elevated D-dimer levels.
D) Increased platelet count.
Correct Answer: C) Elevated D-dimer levels.
Explanation: DIC is characterized by the widespread activation of the clotting cascade, which
paradoxically leads to both massive clotting and hemorrhage due to the consumption of clotting
factors. D-dimer is a degradation product of fibrin; its elevation indicates active, widespread
fibrinolysis occurring after massive clot formation. Fibrinogen and platelets (A & D) are
consumed and thus typically decrease in DIC, and PT (B) typically prolongs, not shortens.
Question 7: A patient is scheduled for an esophagogastroduodenoscopy (EGD). Which nursing
action is essential during the post-procedural recovery period?
, A) Encourage the patient to drink clear liquids immediately upon return.
B) Assess for a return of the gag reflex before allowing oral intake.
C) Position the patient in a prone position to prevent aspiration.
D) Check the patient for signs of post-procedure diarrhea.
Correct Answer: B) Assess for a return of the gag reflex before allowing oral intake.
Explanation: During an EGD, the patient's throat is anesthetized with a local spray, which
suppresses the gag reflex. Allowing oral intake before this reflex returns poses a significant risk
of aspiration. The patient should be kept NPO until the gag reflex is fully restored. Prone
positioning is not standard, and diarrhea is not a primary concern post-EGD.
Question 8: A client with chronic kidney disease (CKD) is prescribed epoetin alfa. The nurse
determines the medication is effective by observing:
A) A decrease in blood pressure.
B) An increase in serum creatinine.
C) An increase in hemoglobin and hematocrit levels.
D) A decrease in serum phosphate levels.
Correct Answer: C) An increase in hemoglobin and hematocrit levels.
Explanation: Epoetin alfa is a synthetic erythropoietin used to treat anemia associated with
chronic kidney disease by stimulating the bone marrow to produce red blood cells. Its
therapeutic effect is measured by improved RBC indices (hemoglobin/hematocrit). It does not
lower blood pressure (it can actually increase it), and it has no direct effect on creatinine or
phosphate levels.
Question 9: A patient is admitted with a suspected pulmonary embolism (PE). What is the
priority nursing intervention while waiting for diagnostic confirmation?
A) Administering a bolus of intravenous heparin.
B) Elevating the head of the bed and initiating supplemental oxygen.
C) Encouraging early ambulation to prevent further clot formation.
D) Performing a focused neurological assessment.
Correct Answer: B) Elevating the head of the bed and initiating supplemental oxygen.
