NURS 201 Final Quiz V2 | NURS 201
Medical Surgical Nursing | Actual Q&A
with Rationale (NURS201 Final Quiz) |
West Coast University
1. A nurse is caring for a client with heart failure who is experiencing dyspnea and crackles on
auscultation. Which of the following medications should the nurse expect to administer first?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Lisinopril
Answer: C
Rationale: Furosemide is a loop diuretic that acts quickly to reduce fluid volume in
patients with heart failure and pulmonary edema. The presence of crackles indicates fluid
overload in the lungs, making diuresis the priority intervention. The nurse must monitor
the patient’s potassium levels and intake/output closely after administration.
2. A patient who has Type 1 Diabetes Mellitus is found unconscious and clammy. What is the
priority nursing action?
A. Check blood glucose level
B. Administer Glucagon IM
,C. Give 15g of simple carbohydrates
D. Call the rapid response team
Answer: B
Rationale: In an unconscious patient suspected of hypoglycemia, restoring glucose levels
immediately is the priority to prevent brain damage. Glucagon is administered
intramuscularly when the patient cannot safely swallow oral carbohydrates. Once the
patient is conscious, the nurse should follow up with a complex carbohydrate and protein
snack.
3. A nurse is reviewing arterial blood gas (ABG) results: pH 7.30, PaCO2 55, HCO3 26. Which
acid-base imbalance does this represent?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: B
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45,
indicating a respiratory cause. The bicarbonate level is within the normal range, suggesting
no compensation has occurred yet. This pattern is commonly seen in patients with
respiratory depression or chronic obstructive pulmonary disease.
, 4. During a post-operative assessment, the nurse notes that a patient’s surgical wound has
eviscerated. What is the immediate nursing intervention?
A. Apply a dry sterile dressing
B. Place the patient in a High-Fowler’s position
C. Push the organs back into the abdominal cavity
D. Cover the wound with sterile towels moistened with normal saline
Answer: D
Rationale: Evisceration is a medical emergency where internal organs protrude through a
surgical incision. The nurse must keep the organs moist and sterile to prevent tissue
necrosis and infection. The patient should also be placed in a low-Fowler’s position with
knees bent to reduce abdominal pressure.
5. A patient presents with a serum potassium level of 6.2 mEq/L. Which of the following
orders should the nurse clarify with the provider?
A. Spironolactone
B. Intravenous insulin and dextrose
C. Sodium polystyrene sulfonate
D. Calcium gluconate
Answer: A
Medical Surgical Nursing | Actual Q&A
with Rationale (NURS201 Final Quiz) |
West Coast University
1. A nurse is caring for a client with heart failure who is experiencing dyspnea and crackles on
auscultation. Which of the following medications should the nurse expect to administer first?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Lisinopril
Answer: C
Rationale: Furosemide is a loop diuretic that acts quickly to reduce fluid volume in
patients with heart failure and pulmonary edema. The presence of crackles indicates fluid
overload in the lungs, making diuresis the priority intervention. The nurse must monitor
the patient’s potassium levels and intake/output closely after administration.
2. A patient who has Type 1 Diabetes Mellitus is found unconscious and clammy. What is the
priority nursing action?
A. Check blood glucose level
B. Administer Glucagon IM
,C. Give 15g of simple carbohydrates
D. Call the rapid response team
Answer: B
Rationale: In an unconscious patient suspected of hypoglycemia, restoring glucose levels
immediately is the priority to prevent brain damage. Glucagon is administered
intramuscularly when the patient cannot safely swallow oral carbohydrates. Once the
patient is conscious, the nurse should follow up with a complex carbohydrate and protein
snack.
3. A nurse is reviewing arterial blood gas (ABG) results: pH 7.30, PaCO2 55, HCO3 26. Which
acid-base imbalance does this represent?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: B
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45,
indicating a respiratory cause. The bicarbonate level is within the normal range, suggesting
no compensation has occurred yet. This pattern is commonly seen in patients with
respiratory depression or chronic obstructive pulmonary disease.
, 4. During a post-operative assessment, the nurse notes that a patient’s surgical wound has
eviscerated. What is the immediate nursing intervention?
A. Apply a dry sterile dressing
B. Place the patient in a High-Fowler’s position
C. Push the organs back into the abdominal cavity
D. Cover the wound with sterile towels moistened with normal saline
Answer: D
Rationale: Evisceration is a medical emergency where internal organs protrude through a
surgical incision. The nurse must keep the organs moist and sterile to prevent tissue
necrosis and infection. The patient should also be placed in a low-Fowler’s position with
knees bent to reduce abdominal pressure.
5. A patient presents with a serum potassium level of 6.2 mEq/L. Which of the following
orders should the nurse clarify with the provider?
A. Spironolactone
B. Intravenous insulin and dextrose
C. Sodium polystyrene sulfonate
D. Calcium gluconate
Answer: A
